Supervisor, Shp Operations, Edi

3 days ago


Sacramento, United States Sutter Health Full time

**Organization**:
Sutter Health Plan - Valley

**Position Overview**:
The Supervisor, SHP Operations, EDI will be responsible for the following:

- EDI file processing metrics - daily/monthly
- Issue prioritization and remediation with HE/Axion - daily
- Quality review - daily
- Support inquiries and transactional team needs - daily
- Team and internal first point of contact - daily
- Working supervisor role maintains reduced scope of current file processing workload - daily
- Deman/capacity forecasting - quarterly
- Account/broker, EDI vendor escalations and meeting support - as needed
- Training - as needed

**EDUCATION**:

- HS Diploma or General Education Diploma (GED)

**PREFERRED EXPERIENCE**:

- 5 years of recent relevant experience.

**SKILLS AND KNOWLEDGE**:

- Requires in-depth working knowledge of office procedures and organization in a managed healthcare setting.
- Thorough knowledge of resource based relative value scale (RBRVS), Current Procedure Terminology (CPT) and International Classification of Diseases (ICD) coding, Healthcare Common Procedure Coding (HCPC) and medical terminology.
- Understanding of a variety of medical claims processing procedures.
- Understanding of standard payment rules.
- Knowledge of state and federal regulations.
- Principles and practices of medical management with emphasis on authorization processes.
- Communicate (written and orally) and work effectively with others.
- Work independently and as a team member.
- Identify to analyze and resolve complex claims issues.
- Ability to correctly interpret HMO benefits and contractual provisions.
- Ability to handle large volumes of claims.
- Manage time effectively for self and others.
- Meet deadlines and productions standards.
- Ability to analyze data.

**Job Shift**:
Days

**Schedule**:
Full Time

**Shift Hours**:
8

**Days of the Week**:
Monday - Friday

**Weekend Requirements**:
None

**Benefits**:
Yes

**Unions**:
No

This position is work from home eligible.

**Position Status**:
Exempt

**Weekly Hours**:
40

**Employee Status**:
Regular

**Number of Openings**:
1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $39.07 to $58.61 / hour



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