If you are interested in joining the SunStone Consulting team, please send your resume to inquiries@sunstoneconsulting.com.

 

Current Openings

 
 

Senior Consultant - Financial Analyst

Energic team player with a passion for healthcare, dedicated to advancing SunStone Consulting’s consultative solutions effectively and efficiently. The ideal candidate can work independently in a home office setting, is a problem-solver, taking on challenges independently with a strong attention to detail.  This role within the Revenue Cycle Service Line will perform a wide range of activities supporting transparent pricing, CDM and charge capture solutions. 

Experience in the healthcare revenue cycle, payer contracting and reimbursement, as well as a strong business acumen, critical thinking proficiency, and strong communication skills.  SunStone values ingeunity within each team members role which enable us to conntinually enhance our solutions.  An essential ingredient to our success is understanding the critical balance between work and home. 

Responsibilities

  • Support management reporting and analysis for clients, maintaining formal audit processes/specifications to ensure repeatability.

  • Assist with the development of non-standard reporting, being attentive to new processes that will transform our solutions.

  • Understand the intricacies of governmental and third party payer reimbursement models.

  • Evaluate third party payer contract information received from client, and model contract terms and/or reimbursement within the appropriate matrix’s.

  • Develop payer specific rate packages based on the scope of work for each engagement.

  • Be attentive for improvements to internal process improvement opportunities, as well as opportunities to enhance client processes.

  • Collaborate effectively, participating in cross-functional meetings with Service Lines and IT to ensure superior results.

  • Continually validate processes, troubleshooting when necessary, to ensure client objectives.

  • Assist with the development and ongoing enhancements to SunStone’s DataLakehouse, including implementation of large datasets for analysis and reporting. 

  • Assist other Service Lines with reporting needs such as data analytics and sampling.

Qualifications

  • Associate or bachelor’s degree in finance, economics  or  IT, with a minimum of 5+ years of multi-entity health system and/or related degree or experience.

  • Job duties are project-based, working collaboratively with managers, team members and multiple Service Lines and IT.

  • Proficient with advance Excel skills (i.e., pivot tables, v-lookups, charts, etc.).

  • Knowledge of Microsoft Power BI and SQL.

  • Ability to handle multiple projects and deadlines with an attention to detail and ability to follow instructions to deliver superior results.

  • Demonstrates independent judgment, discretion, accuracy, analytical skills and decision-making abilities.

Senior Consultant - Inpatient CDI

Energic team player with a passion for healthcare, dedicated to advancing SunStone Consulting’s consultative solutions effectively and efficiently. The ideal candidate can work independently in a home office setting, is a problem-solver, taking on challenges independently with a strong attention to detail.  This role within the Revenue Integrity Service Line will perform a wide range of activities supporting inpatient documentation, coding and billing solutions. 

Proficient with inpatient documentation, coding and billing, working within a culture which emphasizes open communcation and opportunities for growth, SunStone values ingeunity within each team members role which enable us to conntinually enhance our solutions.  An essential ingredient to our success is understanding the critical balance between work and home. 

 Responsibilities:

  • Conduct inpatient and MS-DRG documentation, coding and billing reviews to identify opportunities for clinical documentation improvement, clarifying conditions/diagnosis and procedures to identify potential compliance risks and/or coding improvements.

  • Apply knowledge of Official Coding Guidelines for ICD-10-CM and ICD-10-PCS, Coding Clinic and CPT Assistant to various coding situations.

  • Assist with governmental or third-party payer denials by evaluating compliance with coding guidelines, LCD’s, NCD’s and any applicable CMS or managed care payer guidelines.

  • Demonstrated proficiency in preparing accurate and thorough work papers, with clinically credible documentation references to support findings.

  • Develops education material and conduct education with clients on clinical documentation and coding opportunities, to include practitioners, clinical staff, allied health professionals and coders.

  • Conducts research surrounding governmental or third-party payer guidelines by evaluating applicable coding guidelines, LCD’s, NCD’s and any applicable CMS or payer guidelines.

  • Be attentive for improvements to internal process improvement opportunities, as well as opportunities to enhance client processes.

  • Collaborate effectively, participating in cross-functional meetings to ensure superior results.

Qualifications:

  • Bachelor of Science Degree in Health Information Management or/ Current licensure as a Registered Professional Nurse; BSN preferred. 

  • Minimum of 5+ years of multi-entity health information and/or clinical/coding experience.

  • Strong clinical background with knowledge of anatomy, physiology and medical terminology commensurate with the ability to correctly code various types of services and diagnoses.

  • Ability to communicate and collaborate effectively with managers, clients and team members.

  • Demonstrates independent judgment, discretion, accuracy, analytical skills and decision-making abilities.

  • Proficient in Microsoft Office Suite including Word, Excel and e-mail application.

Medical Billing Supervisor

Overview:  We are seeking a qualified and dedicated medical biller/analyst to join our reimbursement and revenue consulting practice

Job Type:  Full-time

Job Description

This person will be responsible for a variety of tasks requiring data analysis, evaluation, and judgment.  To succeed in this position, the candidate must possess a working knowledge of billing software, medical insurance contracts, and be able to demonstrate excellent written and verbal communication skills. Communication with other consulting team members, clients, and insurance representatives will form a large part of the day to day functions.  Primary duties for this position will include the following:

  1. Working with various billing software applications

  2. Submitting Medicare and managed care claims and adjustment claims

  3. Tracking insurer payments and analyzing contractual allowances

  4. Pursuing denied claims through electronic and written appeal

  5. Conducting follow-up and resolution with insurers

  6. Performing medical record analysis

  7. Analyzing patient benefit eligibility information

 

Desired Experience

  1. A minimum of five years of experience as a medical inpatient biller in a high-volume healthcare setting.  Strong desire for supervisory experience

  2. Thorough understanding of Medicare and managed care insurer billing, reimbursement and terminology

  3. Proficient with Microsoft Office products including Excel and Teams

  4. Familiarity with Medicare DDE/FSS0/HETS systems

  5. EPIC and/or other third-party billing systems

  6. Must have the ability to work independently, mentor others and manage time effectively