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).
Job Summary:
The Clinical Auditor 2 performs audits of medical records on behalf of hospital clients for denials review, defense audits, disallowed charges, and utilization reviews. This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and Milliman (MCG) in addition to criteria established by state Medicaid programs or hospital policy. Audit and analysis must be accurate and consistently ensure a high level of quality, knowledge of laws, rules, regulations and guidelines necessary to ensure compliance and protection of information.
Primary / Essential Functions:
The Primary/ essential job duties may not be exhaustive.
Clinical Staff Responsibilities:
o Defense Audits
o Patient Inquiry Audits
o Disallowed Charges
o Biller Requested Audits
o Avoidable day studies
o Managed care, Medicare or Medicaid reconsiderations/appeals
o Medicare or Medicaid RAC appeals or other specialized Audit Appeals (e.g. CERT, ZPIC, SMRC)
Competencies:
· Puts Clients First
· Drives for Results
· Understands our Business
· Thinks Innovatively
· Values Differences
· Builds Teamwork
· Gains Trust
· Communicates Effectively
· Shows Accountability
· Takes Action
· Embraces Change
· Makes Quality Decisions
Physical / Mental Demands, Environment:
Equipment Used:
Telephone, fax, calculator, computer, monitor, printer, hardware and software packages, computer peripheral equipment i.e. mouse and keyboard; and Microsoft software.
Minimum Qualifications:
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 $28.00 to $38.00. 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.
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