Sanford Health

Claims Specialist

• Responsible for processing health insurance claims submitted via paper or electronically by providers and members
• Validates health insurance claims with an understanding of health insurance cost sharing, limitations, and exclusions
• Reviews claims for completeness and accuracy
• Releases health insurance claims for payment according to the defined workflows
• Works assigned pend and error reports
• Determines benefit level to be paid according to the summary plan language
• Responds promptly to requests for information from other Sanford Health Plan departments
• Refers complex claims to Senior and/or Lead Claims Representatives.

Associate Claims Representative

Administration

• Oversee the overall functionality of the REDCap instance, apply software updates and patches.
• Collaborate with researchers to translate study protocols into functional REDCap databases, surveys, and longitudinal instruments using data validation rules and calculated fields.
• Grant and manage user permissions, ensure data integrity, and implement data security controls to protect sensitive research information.
• Provide technical troubleshooting and training sessions for researchers, coordinators, and students on REDCap functionality and best practices.
• Utilize programming and scripting languages (e.g., SQL, API integrations) to extend REDCap's capabilities and integrate with other institutional systems like Epic.
• Ensure all data collection and storage align with institutional policies, ethical guidelines, and regulatory standards.

Lead Applications Administrator – IT Research

Support Engineer

• Performs routine healthcare information system and application support
• Utilizes analytical skills and experiences to investigate or escalate support issues
• Resolves incidents and services requests
• Assists in the creation and maintenance of training documentation
• Incorporates appropriate presentation techniques to support and/or lead training sessions
• Researches, analyzes and makes recommendations for application workflow improvements
• Creates and analyzes reports created using multiple reporting mechanisms
• Gathers, analyzes, designs, develops, modifies, tests, implements, evaluates, and maintains information technologies to support business needs
• Promotes and participates in a team approach
• Works with other departments and outside vendors
• Comfortable managing change with excellent problem solving skills
• Time management and prioritization of tasks on a daily basis
• Proficient verbal and written communication required
• Positive attitude and excellent customer service skills are expected
• Ability to communicate diplomatically across integrated teams
• Good interpersonal skills
• Proficiency with software such as word processing, spreadsheets, databases, and presentation software required

Applications Support Analyst – Health Plan

Operations

• Provides day-to-day guidance and supervision to administrative staff.
• Maintains office services by organizing office operations and procedures; approving employee time; controlling correspondence; designing filing systems; reviewing and approving supply requisitions; assigning and monitoring clerical functions for all departments within designated area.
• Coordinates administrative and support functions of one or more executives and management personnel.
• Maintains office efficiency by planning and implementing office systems, layouts, and equipment procurement.
• Completes operational requirements by scheduling and assigning employees; following up on work results.
• Supervises administrative staff by recruiting, selecting, orienting and training employees.
• Maintains office staff job results by coaching, counseling and disciplining employees; planning, monitoring and appraising job results.
• Prepares administrative budgets and participates in development of operational and administrative policies.
• Organizes and coordinates large meetings and conferences.
• Monitors effectiveness of support staff; recommends improvements.

Supervisor, Operations Support

Administrative Assistant

• Performs clerical and managerial duties in support of multiple departments and leaders.
• Responsible for specific tasks requiring data entry, department ordering, time and attendance, production improvement and phone services.
• Provides project support as needed.
• Provide training and orientation to new staff.
• Respects and maintains confidentiality of all verbal and written communications.

Senior Administrative Assistant

Analyst

• Responsible for the coordination, documentation, communication and analysis of provider productivity, compensation and benefits
• Performs quantitative and qualitative analysis of healthcare and financial data to support program management within the physician and advanced practice provider compensation department
• Summarize provider revenues and work relative value units (WRVUs)
• Gather data for payroll processing and benefit day tracking
• Assist in the overall preparation and design of monthly compensation process, budget, and survey and market analysis through data gathering, entry and validation
• Maintains financial records and documentation

Physician Compensation Analyst

Therapist

• Plans, organizes and delivers physical therapy programs that help clients/patients/residents recover and improve their mobility
• Conducts examinations, evaluations, and interventions clients/patients/residents who are affected by injury or disease
• Educates clients/patients/residents and their family members about treatment plans/schedules and self-exercises to be continued at home
• Supervise assistants, aides, and students as they provide client/patient/resident care, treatment, or other services

Physical Therapist

• Works collaboratively as part of the clinical team.
• Develops and maintains EMR's utilized for service line documentation of care delivery.
• Completes policy review and provides updates as warranted.
• Reviews billing and coding as well as intermittently assist in denial management.
• Coordinates and oversees student placement, ensuring appropriate support, supervision, and monitoring throughout the clinical rotation.

Therapy Clinical Consultant

• Responsible for the accuracy, completeness, and required regulatory filings of the Health Plan’s provider network.
• Serves as a resource for strategic planning, compliance, and network analysis.
• Completes network adequacy reviews, in collaboration with the Health Plan's Business Intelligence Department representatives.
• Performs analyses and audits to identify gaps in current provider networks.
• Coordinates required regulatory provider network submissions to ensure HP meets contractual obligations.
• Maintains accurate data in HP Provider Directory.

Provider Network Data Integrity Analyst, Health Plan

Medical Billing and Coding

• Review medical documentation and assign appropriate codes (ICD-10, HCPCS, CPT)
• Ensure compliance with coding standards, regulations, and company procedures
• Resolve coding and denial review issues
• Participate in coding team meetings as a subject matter expert
• Provide training on coding guidelines to healthcare providers

Coder, Provider Practice – Endocrinology & Diabetes Self-Management

• Review medical documentation from physicians and other healthcare providers
• Assign modifiers, diagnostic and procedure codes for symptoms, diseases, injuries, surgeries and treatments according to official classification systems and standards
• Provide accurate and timely ICD-10-CM coding of diagnoses, HCPCS and CPT coding
• Review and audit medical record documentation accurately to reflect healthcare coding and substantiate appropriate service reimbursement
• Convey coding guidelines to physicians and other healthcare providers to improve the accuracy of medical record documentation
• Participate in coding team meetings and serve as a subject matter expert.

Coder, Provider Practice – Hospitalist

Graphics Designer

• Designs digital and print materials that support training for patients and staff.
• Applies graphic design principles to enhance training initiatives, maintain organizational brand standards, and meet stakeholder needs.
• Supports learning and development by enhancing the visual design elements of course design and supporting materials.
• Responsible for maintaining and updating existing training and educational content as delegated.
• Customizes curriculum and develops training materials to ensure that organizational and stakeholder needs are met.
• Delivers training utilizing adult learning principles and training methods.
• Performs quality checks to ensure satisfactory course functionalities and objectives are met.
• Coordinates training schedules as needed for intended audience and population.
• Works closely with remote subject matter experts regarding the design, build, and maintenance of training content needs based on educational course topics and the initiatives driven within the department.

Learning and Development Specialist – Graphic Design

Technical Project Manager

• Administer projects on a day-to-day basis, and verify that they produce the required deliverables of quality within the specified constraints of time and cost.
• Ensure resource availability and allocation.
• Coordinate internal resources, third parties and vendors for the flawless execution of projects.
• Develop project scopes and objectives, involving all relevant stakeholders and ensuring technical feasibility.
• Use appropriate verification techniques to manage changes in the project scope, schedule and costs.
• Manage relationships with all stakeholders, establish and maintain relationships with third parties and vendors.
• Report and escalate any issues to management as needed.
• Develop a detailed project plan to track progress, and measure project performance using the appropriate systems, tools and techniques.
• Identify and assess risks and facilitate resolution to minimize project risks.
• Create and maintain comprehensive project documentation.

IT Project Manager

Systems Engineer

• Designing, implementing, and securing enterprise identity and access management infrastructure
• Ensuring authentication, authorization, and access management across hybrid environments
• Leading the architecture of domain topologies and global replication
• Driving the adoption of modern authentication protocols
• Integrating systems through API calls (REST, SOAP, JSON)
• Managing enterprise PKI and certificate lifecycles
• Enforcing security baselines via Group Policy
• Mentoring junior engineers in best practices

Senior Identity System Engineer

Customer Support

• Provide effective and efficient handling of phone calls from or to Sanford Health members, providers, and colleagues ensuring a positive experience for all members
• Assess the level of complexity of cases and provide resolution or facilitate escalation of phone call inquiries
• Provide positive, consistent customer experiences by striving for excellence in understanding and resolving specific requests while showing patience, empathy, compassion and sincerity
• Respond to customer questions via inbound and outbound telephone calls and written correspondence
• Partner with other Sanford Health departments as needed to coordinate inquiries requiring in-depth research to ensure customer satisfaction regarding member and provider questions
• Thoroughly document interaction for accurate tracking and analysis
• Promote the usage of self-service to callers as appropriate
• Provide end-user support including navigational questions, basic system issue resolution, and escalation as applicable