Payment Variance Auditor I

Savista; United States; On-site; USD 44,000 - 50,000; Full time

Job summary

Savista, a leader in healthcare revenue cycle services, seeks an Underpayment Auditor I to review payment data and contract terms, identify underpayments, and help recover revenue for clients. You will analyze patterns, verify policies, and collaborate with the Compliance Program to ensure HIPAA and related laws are observed.

Ideal candidates have 1–2 years in managed care reimbursement, strong analytical skills, and proficiency with MS Office.

Qualifications

• High school diploma or GED is required.
• 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.
• Self-motivated and independent with strong analytical skills.
• Excellent oral and written communication skills.

Responsibilities

• Review historical payment information using high-volume reports to assess reimbursement accuracy.
• Evaluate hospital contracts to ensure proper application of rates, provisions and terms.
• Identify underpayment trends by comparing contracts to actual payments via contract management tools.
• Apply analytical methods to remove inaccuracies and reduce false positives.
• Investigate third-party payor policies and contracts for accuracy of variances per guidelines.
• Collaborate with Contract Specialist team to refine models when discrepancies are found.
• Verify patient benefits and eligibility to screen out denials and demographic issues.
• Report underpayments and trends to management and audit teams for pursuit and collection.

Skills

Strong analytical acumen

Excellent oral and written коммуника

Self-motivated and independent

Strong leadership skills

Proficiency with MS Office

ICD-9/ICD-10, CPT Coding, UB and 1500

Education

High school diploma or GED

1-2 years of experience with managed care reimbursement and contracts

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. 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 I

Essential Duties & Responsibilities:

• 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
• Applies analytical techniques during report review to remove inaccurate information and potential false positive returns
• 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
• Makes 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 trends
• Reports underpayments and underpayment trends to management and audit team for pursuit and collection
• When necessary, updates reason for pursuit and pursued amounts to accurately reflect current information
• 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.
• Meets established individual and team goals for volume and value of underpayments identified
• 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.

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 formats
• Self-motivated and independent
• Strong analytical acumen.
• Proficiency with MS Office
• Strong 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.

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