Coding and Billing Auditor

Savista; Texas; On-site; USD 55,000 - 75,000; Full time

Job summary

Savista in Texas is seeking an Underpayment Auditor I to review claims and payment data, identify underpayments, and help resolve discrepancies. The role requires a high school diploma and 1–2 years of managed care reimbursement experience, with familiarity in ICD-9/10, CPT coding and revenue codes, UB and 1500 formats, and MS Office proficiency.

Strong communication skills and adherence to HIPAA, FDCPA, FCRA, and other applicable laws are essential to protect patient information and support

Qualifications

• High school diploma or GED.
• 1-2 years of experience with managed care reimbursement and contracts.
• Familiar with ICD-9 and ICD-10, CPT Coding, revenue codes, UB and 1500 billing formats.
• Proficiency with MS Office.
• Salary range must be included where legally required in applicable locations.

Responsibilities

• Review high-volume reports to assess reimbursement accuracy.
• Examine hospital contracts to apply rates, provisions and terms.
• Identify underpayment trends by comparing contracts to payments.
• Investigate payor policies and contracts for variance accuracy.
• Report underpayments and trends to management and audit teams.

Skills

Communication skills

Attention to detail

Analytical thinking

Education

High school diploma or GED

Tools

MS Office

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). This position is responsible for reviewing claims and payment information and underpayment identification systems to identify potential individual underpayments and underpayment trends. The auditor must ensure that all underpayment trends are identified so as to use best practices and processes to resolve.

Underpayment Auditor I

• Makes use of high-volume reports to review historical payment information and determine the accuracy of reimbursements
• Reviews hospitals managed care contracts to determine appropriate application of rates, provisions and terms
• Identifies potential underpayment trends through comparison of managed care contracts to actual reimbursement information via contract management technology
• Investigates third party payor policies and contracts to verify accuracy of underpayment variances according to published payor guidelines
• Interfaces with Contract Specialist team to refine contract models if discrepancies are identified
• Reports underpayments and underpayment trends to management and audit team for pursuit and collection
• Communicates well both verbally and in writing, has good listening skills, builds strong relationships, is flexible/open-minded, negotiates effectively, solicits performance feedback and handles constructive criticism.
• Supports Savista’s Compliance Program by adhering to policies and procedures pertaining to HIPAA, FDCPA, FCRA, and other laws applicable to Savista’s business practices. This includes: becoming familiar with Savista’s Code of Ethics, attending training as required, notifying management or Savista’s Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations.

• High school diploma or GED.
• ~1-2 years of experience working with managed care reimbursement and contracts.
• ~ Familiar with ICD-9 and ICD-10, CPT Coding, revenue codes, UB and 1500 billing formats
• ~ Proficiency with MS Office
• ~ Savista is required by state-specific laws to include the salary range for this role when hiring a resident in applicable locations. 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.