AR Specialist 2- Complex Clinical Denials

Savista, LLC; Pennsylvania; Hybrid; USD 23.000 - 32.000; Vollzeit

Zusammenfassung

Savitsa, LLC helps healthcare providers improve revenue cycle performance while maintaining compliant, patient-centered care. The Medical Insurance Accounts Receivable Representative will focus on timely collection of government or commercial insurance receivables.

Essential duties include eligibility verification, claim research, and payer communications to secure payment. Candidates should have 2–3 years in medical collections and strong knowledge of ICD-10, CPT, HCPCS, and EMR systems.

Qualifikationen

• Experience in medical collections and resolving denials/appeals.
• Knowledge of ICD-10, CPT, HCPCS and NCCI.
• Familiarity with payer contracts, commercial and government.

Aufgaben

• Verify eligibility and authorization with payers or providers.
• Update demographics in systems and monitor claims.
• Research unpaid or denied claims and resolicit payments.
• Communicate with payers to secure payments and appeals as needed.
• Maintain confidentiality of patient information per policy and law.

Kenntnisse

Medical collections

Denials & appeals

ICD-10/CPT/HCPCS

NCCI knowledge

Payor contracts knowledge

Tools

EMR systems

Claim Scrubbers

Patient Accounting Systems

UB04/1500 forms

Jobbeschreibung

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 & Responsibilities

• Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
• Update patient demographics/insurance information in appropriate systems -
• Research/ Status unpaid or denied claims
• Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
• Research EOBs for payments or adjustments to resolve claim
• Contacts 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 info
• Follow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
• Secure needed medical documentation required or requested by third party insurance carriers
• Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
• Understand, follow, and maintain productivity and performance-based role expectations
• Perform other related duties as required

Minimum Requirements & Competencies

• 2-3 years of medical collections, denials and appeals experience
• Experience 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 NCCI
• Intermediate knowledge of third-party billing guidelines
• Intermediate knowledge of billing claim forms (UB04/1500)
• Intermediate knowledge of payor contracts- commercial and government
• Intermediate Working Knowledge of Microsoft Word and Excel
• Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

Preferred Requirements & Competencies

• Intermediate knowledge of one or more of the following Patient accounting systems: EPIC, Athena, Experian- Claim Source, Collections Management, Cerner, STAR, Meditech Expanse, CPSI, Invision, PBAR, All Scripts or Paragon
• Intermediate knowledge of DDE Medicare claim system
• Intermediate knowledge of government rules and regulations

Note: Savista 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 $17.00 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.