Claims Research Specialist*

Created as a new Sutter Health entity in 1999, Sutter Connect integrates managed care administrative services and physician practice management. As a healthcare Administrative Services Organization (ASO), Sutter Connect provides clients with a comprehensive advantage through experienced managed care leadership, highly effective transaction processing, sophisticated data analysis and seamless connectivity among providers, payers and patients.Sutter Connect is focused on being recognized as a national leader in its full services management approach that covers MIS, HR, billing, accounting, strategic development and administration.

Sutter Connect is an Administrative Services Organization providing billing and accounts receivable and managed care administration services to many Sutter Health affiliated organizations and other organizations across Northern California.







The Claims Research Specialist analyzes and adjudicates claims resubmitted due to inappropriate denials, incorrect payment, or funding. Other responsibilities include: anticipating and recognizing problems associated with processing of complex claims which may include a variety of elements requiring independent judgement; consistently evaluating applicable policies and procedures and recommending changes as appropriate; performing special projects as necessary.

REQUIREMENTS
The ideal candidate will have a working knowledge of office procedures in a managed health care environment and a thorough knowledge of CRVS, CPT, HCPCs and ICD-9 coding and medical terminology as well as a clear thorough understanding of State and Federal regulations in regard to standard payment rules. Must possess the ability to analyze complex claims.

Requires a High School Diploma or equivalency; some college or equivalent combination of education and experience in claims processing preferred (as would be acquired in three years).