Sutter Health Operations Auditor - Sutter Health Plus in Sacramento, California
This position is responsible for auditing transactional work for the enrollment, premium billing and medical claims areas within operations for the health plan. This role will complete research and may provide education/training to support various audit activities of Sutter Health Plus operations. The Operations Auditor will perform the activities involved in identifying, examining, testing and making recommendations concerning the internal controls, policies and procedures of the Plan and its subsidiaries. This includes, but is not limited to, internal control reviews, special projects, and system development reviews.
High school diploma/GED required. BA/BS degree or equivalent combination of education and experience desired.
• 5 years’ experience in health plan transaction related operations
• 3 years in health plan insurance claims or compliance audit experience preferred
• Knowledge of regulatory compliance auditing, flowcharting and statistical sampling techniques.
• Previous experience leading or performing audits independently
• Bachelor’s degree in business or accounting or equivalent work experience preferred
• Knowledge of health care operations and structure, general requirements in an integrated delivery system, and use of information system applications in a health insurance or health care environment.
• Excellent organization skills; ability to prioritize multiple activities and objectives in a rapidly changing environment, and deliver quality service.
• Strong skills in word processing, spreadsheet and presentation computer programs, preferably Microsoft.
• Knowledge of health insurance concepts related to premium billing, claims and enrollment/eligibility processes.
• Experience interacting with health care providers and familiarity with health care billing and payment practices.
• Prior demonstrated success in progressively responsible positions in health care or managed care industry with strong results-oriented skills.
• Must have knowledge of database management and data accuracy verification techniques.
• Ability to lead, communicate and interact with all levels of the organization, including senior management, to provide recommendations and influence decision-making.
• Experience in managing multiple, simultaneous, complex programs.
• Must possess some familiarity and understanding of DMHC regulations, various health care reimbursement models, pricing mechanisms, managed care and payer relationships.
• Required skills include ability to build collaborative working relationships with diverse individuals and organizations; strong analytical and problem solving skills; ability to operate independently, confidentially, and to garner confidence from SHP leadership, Sutter affiliates, vendors and consultant staff and Sutter Physician Services staff.
• Ability to work within and promote team environment concepts; exceptional interpersonal skills including oral and written communications in a wide variety of circumstances.
• Ability to maintain confidentiality in all activities.
Organization: *Sutter Health Plan
Title: Operations Auditor - Sutter Health Plus
Location: California-Greater Sacramento Area-Sacramento
Requisition ID: SHP-1716225
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.