Underpayment Auditor 1

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 through underpayment identification systems to identify potential underpayments and underpayment trends.  Identified potential underpayments and trends will be analyzed and screened to remove false variances, enabling other team members to pursue lost revenue on behalf of Underpayment Recovery clients.

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. 
• Provides management and colleagues with feedback on client inventory analysis and payer trends  
• 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.  
• Keeps information organized and accessible, maintains clean/functional workspace, works systematically/efficiently, and manages time well. Adapts to change, is open to new ideas, takes on new responsibilities, handles pressure, adjusts plans to meet changing needs. 

Requirements:

• High school diploma or GED.  
• At least two years of experience working with managed care reimbursement
• Proven capability utilizing ICD-9 and ICD-10, CPT Coding, revenue codes, UB and 1500 billing formats to conduct A/R activities
• Strong analytical acumen
• Self-motivated and independent
• Ability to train and mentor team members
• Excellent oral and written communication skills.
• Demonstrated ability to navigate Internet Explorer and Microsoft Office, including the ability to input and sort data, filter cells, and use basic formulas in Microsoft Excel and use company email and calendar tools. 
• Demonstrated success working both individually and in a team environment.
• Ability to work effectively with cross-functional teams to achieve goals. 
• Demonstrated ability to meet performance objectives. 

Preferred Skills:

• Experience with Epic, Meditech, Cerner, Paragon, Soarian, Collections Management or STAR.  
• Experience working with or for a hospital/hospital system with more than 250 beds.  
• Experience with both hospital (facility) and physician (pro-fee) contracts.  
• Prior healthcare experience in accounts receivable follow-up and payer communication 

Note: 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 $17.97 to $28.24. 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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