Payment Variance Auditor I

Savista, LLC; Alpharetta (GA); Sur place; USD 44 000 - 50 000; Plein temps

Résumé du poste

Savista, LLC in Alpharetta, GA is seeking an Underpayment Auditor I to review claims and payment data, identify underpayments, and support recovery efforts for healthcare clients.

You will analyze contracts, apply data analytics, verify patient benefits, and collaborate with contract specialists while maintaining HIPAA compliance and strong communication.

Qualifications

• High school diploma or GED
• 1-2 years experience in managed care reimbursement and contracts
• Knowledge of ICD-9/ICD-10, CPT coding, revenue codes, UB and 1500 billing formats
• Proficiency with MS Office
• Strong analytical and communication skills
• Leadership abilities

Responsabilités

• Review high-volume reports to verify reimbursement accuracy.
• Review hospitals managed care contracts for rate application and terms.
• Identify underpayment trends by comparing contracts to actual reimbursements.
• Apply analytic techniques to remove false positives.
• Communicate findings to management and audit team for pursuit.
• Support compliance with HIPAA, FDCPA, FCRA and confidentiality requirements

Connaissances

Analytical thinking

MS Office

Oral and written communication

Leadership

Problem solving

Formation

High school diploma or GED

Outils

UB 1500 billing formats

ICD-9/ICD-10 knowledge

CPT Coding

Revenue codes

Description du poste

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. Identified potential underpayments and trends will be analyzed and screened to remove false positives, enabling other team members to accurately and efficiently pursue lost revenue on behalf of Underpayment Recovery clients. The auditor must ensure that all underpayment trends are identified so as to use best practices and processes to resolve.Underpayment Auditor IEssential Duties & Responsibilities:Makes use of high-volume reports to review historical payment information and determine the accuracy of reimbursementsReviews hospitals managed care contracts to determine appropriate application of rates, provisions and termsIdentifies potential underpayment trends through comparison of managed care contracts to actual reimbursement information via contract management technologyApplies analytical techniques during report review to remove inaccurate information and potential false positive returnsInvestigates third party payor policies and contracts to verify accuracy of underpayment variances according to published payor guidelinesInterfaces with Contract Specialist team to refine contract models if discrepancies are identifiedMakes efforts and utilizes available resources to verify patient benefits and eligibility to screen out denials, plan type and other demographic information that may negatively impact the accuracy of identified potential underpayment trendsReports underpayments and underpayment trends to management and audit team for pursuit and collectionWhen necessary, updates reason for pursuit and pursued amounts to accurately reflect current informationCommunicates 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.Meets established individual and team goals for volume and value of underpayments identifiedSupports 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.Minimum Requirements & Competencies: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 formatsSelf-motivated and independentStrong analytical acumen.Proficiency with MS OfficeStrong leadership skills.Excellent oral and written communication skills.Pay Transparency Disclaimer*Savista is required by state-specific laws to include the salary range for this role when hiring a resident in applicable locations. The annual range for this role is $43,870-$50,000 annually. 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.California Job Candidate Notice