AR Specialist 2, Complex Clinical Denials

Savista; United States; On-site; USD 28,000 - 32,000; Full time

Job summary

Savista seeks a detail-oriented Medical Claims Specialist to support revenue cycle activities. You will verify eligibility, update demographics, and research denied claims to secure timely payments.

You will interact with payers via phone and written correspondence, ensuring compliance with guidelines while protecting patient information. The ideal candidate has 2–3 years of medical collections experience, strong coding knowledge (ICD-10, CPT, HCPCS, NCCI), and familiarity with EMR systems.

Qualifications

• 2-3 years of medical collections, denials and appeals experience.
• Knowledge of DRG downgrades, level of care, coding, medical necessity, and noncovered denials.
• Familiar with ICD-10, CPT, HCPCS and NCCI.
• Experience with payor contracts (commercial and government).
• Proficiency with Microsoft Word and Excel; health information systems.

Responsibilities

• Verify eligibility/authorization using payer sites or phone with carriers.
• Update patient demographics and insurance info in systems.
• Research unpaid or denied claims and monitor for missing info or authorization.
• Contact payers to secure payment, reconsideration, and appeals.
• Access client systems for payment, claims, data; maintain confidentiality.

Skills

Medical collections

Denials & appeals

ICD-10

CPT/HCPCS

NCCI

EMR systems

Excel

Word

Phone/e-mail communication

Tools

EPIC

Cerner

STAR

Meditech

CPSI

PBAR

All Scripts

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).

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, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
• Intermediate knowledge of DDE Medicare claim system
• Intermediate knowledge of government rules and regulations

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 $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.

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