Underpayment Auditor

6 days ago

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Logo of Savista

Savista

Revenue Cycle Management • HIM • Patient Engagement • Revenue Integrity • Accounts Receivable Management

1001 - 5000 employees

Founded 1994

⚕️ Healthcare Insurance

Description

• 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.

Requirements

• 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.

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