Sutter Health CBO Supervisor - Contract Compliance, Underpayments in Roseville, California
This position will oversee insurance underpayment identification and pursuit for both Hospital and Physician claims.
Manages Central Business Office (CBO) team daily operations including Billing, Follow Up, Operations, Payer Management and Patient Services functions. Provides supervisory coaching and support; issue identification, assessment, and resolution; and technical support in order to achieve desired outcomes and compliance with Sutter Health policies/procedures and standards. Supports internal controls, monitors employee performance, and performs staff development, retention and selection.
Provides supervisory leadership and direction to the assigned CBO Team. Manages team workload, resources and compliance with Service Level Agreements to ensure CBO activities are executed accurately and efficiently. Ensures adherence to established Sutter policies, government regulations and payer requirements. As a team lead in a shared services environment, assists in establishing and maintaining strong, collaborative relationships with all external customers to identify additional ways to be of service and ensure customer satisfaction.
Supports the success of a high-performing shared services organization by helping to champion and drive the long-term Sutter Shared Services vision. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized. Participates in programs and in using tools in support of building a high performance culture via the standard Sutter Shared Services responsibilities (e.g. performance measurement, people development, customer relationship management, etc.).
Education, Licensures, and Certifications:
• Bachelor's degree in Business or Healthcare Administration Or equivalent education/experience required
• Master's degree preferred
• Certified Coding Specialist – CCS certification required
Experience, Skills and Knowledge:
• Demonstrated leadership experience and a proven track record in Payer-specific (Medicare, Medical, Commercial, PPO, HMO, Work Comp, Government Contracted Payers, Self-pay and other third-party payers) Claims management in a facility of significant size and complexity, hospital business operations, information systems, and patient accounting applications, as typically acquired in 3-6 years of acute hospital CBO management positions required
• Experience developing Payer-specific (Medicare, Medical, Commercial, PPO, HMO, Work Comp, Government Contracted Payers, Self-pay and other third-party payers) Claim standards, processes, policies, procedures and service level agreements required
• Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships desired
• Experience participating in planning new or expanded services and managing projects desired
• Deep familiarity with general hospital management principles, practices, and procedures
• In-depth knowledge/ awareness of all areas related to Payer-specific (Medicare, Medical, Commercial, PPO, HMO, Work Comp, Government Contracted Payers, Self-pay and other third-party payers) Claims and how they interrelate.
• In-depth knowledge of advanced principles, methods, and techniques related to compliant healthcare billing/collections
• A comprehensive knowledge of Payer-specific (Medicare, Medical, Commercial, PPO, HMO, Work Comp, Government Contracted Payers, Self-pay and other third-party payers) Claims management functions in acute and non-acute settings
• Familiarity with work standards and productivity measures, quality control mechanisms, and workload distribution
• Knowledge of technological advancements, labor savings procedures/ processes/ equipment and other state-of-the art department-specific systems
• Knowledge of Patient Management information system applications, preferably EPIC
• Ability to execute strategy and communicate knowledge of business processes and enabling technologies, specifically in a Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims function
• Ability to serve as a reference and coach others on key Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims processes, policies, and procedures
• Aptitude to conceptualize, plan, and implement stated goals and objectives
• Ability to independently set and organize own work priorities for self and for the assigned team, and successfully adapt to new priorities as part of a changing environment. Must be able to work concurrently on a variety of tasks/projects while leading a high volume, high accuracy work team composed of individuals having diverse personalities and work styles
• Ability to communicate and work with patients, physicians, associates, Sutter Health leadership, multiple direct patient care providers and others in order to expedite the patient accounting process. Strong communication skills (verbal and written) in dealing with trainees, associates, and internal/external customers.
• Ability to handle heavy workloads and short deadlines in a positive manner. Adapts quickly to changing conditions, assimilating new processes into job functions and taking ownership.
• Ability to comply with Sutter Health policies and procedures.
• Excellent ability to identify, prioritize, resolve and / or escalate complex problems promptly
• Excellent ability to establish, develop and manage customer relationships
• Ability to learn new applications/software systems effectively and efficiently
• Demonstrated leadership skills and the ability to provide supervision, direction, and constructive feedback to team members to support continuous improvement
• Ability to effectively detect, surface and resolve conflicts among individuals and/or work groups
• Ability to communicate ideas both verbally and in writing to influence others using on-on-one contact and group discussions
• Ability to recognize the appropriate style, level of detail, and message for the audience
• Ability to positively influence others in a desired direction to achieve identified outcomes
• Ability to develop effective working relationships/ networks within and outside the organization
• Skills using spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite
• Well-developed process design, implementation, and improvement skills
• High-level problem identification/ mitigation/ resolution and analytical skills
• Requires the ability to work with and maintain confidential information
Organization: Sutter Shared Services
Employee Status: Regular
Position Status: Exempt
Job Shift: Day
Shift Hours: 8 Hour Shift
Days of the Week Scheduled: Monday-Friday
Weekend Requirements: None
Schedule: Full Time
Hrs Per 2wk Pay Period: 80
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.