AR Specialist 2- Complex Clinical Denials

Savista, LLC; Alpharetta (GA); On-site; USD 28,000 - 32,000; Full time

Job summary

Savista, LLC is seeking a Medical Insurance Accounts Receivable Representative in Alpharetta, GA to ensure timely collection of government or commercial healthcare insurance receivables. You will verify eligibility, update demographics, monitor claims, and contact payers to secure payments, while adhering to guidelines and protecting patient confidentiality.

Minimum 2–3 years in medical collections with knowledge of ICD-10, CPT, HCPCS and NCCI is required; familiarity with major EMR and billing

Qualifications

• 2-3 years of medical collections, denials and appeals experience.
• Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI.
• Intermediate knowledge of health information systems (EMR, Claim Scrubbers, Patient Accounting Systems).

Responsibilities

• Verify/obtain eligibility and/or authorization using payer sites or client systems.
• Update patient demographics/insurance information in systems.
• Monitor claims for missing information, authorization, and control numbers.
• Research EOBs for payments or adjustments to resolve claims.
• Contact payers to secure payment and handle reconsideration/appeals.
• Follow guidelines for timely filing deadlines and documentation.
• Maintain confidentiality of patient information in accordance with policy.

Skills

Medical collections

Denials & appeals

MS Word & Excel

EMR / Claim systems

Tools

EPIC

Cerner

STAR

Meditech

CPSI

Invision

PBAR

AllScripts

Paragon

Job description

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).Savista partners with healthcare providers to improve their financial strength by implementing integrated spend management and revenue cycle solutions that help control cost, improve margins and cash flow, increase regulatory compliance, and optimize operational efficiency.The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.Essential Duties & ResponsibilitiesVerify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providersUpdate patient demographics/insurance information in appropriate systems -Research/ Status unpaid or denied claimsMonitor claims for missing information, authorization, and control numbers (ICN//DCN)Research EOBs for payments or adjustments to resolve claimContacts payers via phone and/or written correspondence to secure payment of claims; reconsideration and appeal submission.Adhere to state and federal claim and appeal guidelines.Access client systems for payment, patient, claim and data infoFollow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systemsSecure needed medical documentation required or requested by third party insurance carriersMaintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedureUnderstand, follow, and maintain productivity and performance based role expectationsPerform other related duties as requiredMinimum Requirements & Competencies2-3 years of medical collections, denials and appeals experienceExperience with all but not limited to the following denials and appeals-DRG downgrades, level of care, coding, medical necessity, experimental, bundling, noncovered, and no authorization.Intermediate knowledge of ICD-10, CPT, HCPCS and NCCIIntermediate knowledge of third-party billing guidelinesIntermediate knowledge of billing claim forms (UB04/1500)Intermediate knowledge of payor contracts- commercial and governmentIntermediate Working Knowledge of Microsoft Word and ExcelIntermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)Preferred Requirements & CompetenciesIntermediate knowledge of one or more of the following Patient accounting systems: EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or ParagonIntermediate knowledge of DDE Medicare claim systemIntermediate knowledge of government rules and regulationsSavista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $20.00 to $23.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.California Job Candidate Notice