Offer summary

Qualifications:

3-5 years of experience in medical collections, denials, and appeals., Advanced knowledge of ICD-10, CPT, HCPCS, and NCCI coding systems., Familiarity with third-party billing guidelines and claim forms (UB04/1500)., Proficient in Microsoft Word and Excel, and health information systems..

Key responsabilities:

Verify and obtain eligibility and authorization from insurance providers.

Research and status unpaid or denied claims, ensuring timely collection.

Contact payers to secure payment and submit appeals as necessary.

Maintain confidentiality of patient information and adhere to claim guidelines.

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).

Savista partners with healthcare providers to improve their financial strength by implementing integrated spend management and revenue cycle solutions that help control cost, improve margins and cash flow, increase regulatory compliance, and optimize operational efficiency.

The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.

Essential Duties & Responsibilities

Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
Update patient demographics/insurance information in appropriate systems -

Research/ Status unpaid or denied claims
Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
Research EOBs for payments or adjustments to resolve claim
Contacts payers via phone and/or written correspondence to secure payment of claims; reconsideration and appeal submission.
Adhere to state and federal claim and appeal guidelines.
Access client systems for payment, patient, claim and data info

Follow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
Secure needed medical documentation required or requested by third party insurance carriers
Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
Understand, follow, and maintain productivity and performance based role expectations
Perform other related duties as required

Minimum Requirements & Competencies

3-5 years of medical collections, denials and appeals experience
- Experience with all but not limited to the following denials and appeals-

DRG downgrades, level of care, coding, medical necessity, experimental, bundling, noncovered, and no authorization.

Advanced knowledge of ICD-10, CPT, HCPCS and NCCI
Advanced knowledge of third-party billing guidelines
Advanced knowledge of billing claim forms (UB04/1500)
Advanced knowledge of payor contracts- commercial and government

Advanced working knowledge of Microsoft Word and Excel
Advanced knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

Preferred Requirements & Competencies

Advanced knowledge of one or more of the following Patient accounting systems: EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
Advanced knowledge of DDE Medicare claim system

Advanced knowledge of government rules and regulations

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 $21.00 to $24.00. 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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