AR Specialist 2- Complex Clinical Denials

About 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.

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 claims.
• Contact 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.

Requirements

• 2-3 years of medical collections, denials, and appeals experience.
• Experience with denials and appeals including but not limited to: DRG downgrades, level of care, coding, medical necessity, experimental, bundling, noncovered, and no authorization.
• Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI.
• Intermediate knowledge of third-party billing guidelines.
• Intermediate knowledge of billing claim forms (UB04/1500).
• Intermediate knowledge of payor contracts (commercial and government).
• Intermediate working knowledge of Microsoft Word and Excel.
• Intermediate knowledge of health information systems (e.g., EMR, Claim Scrubbers, Patient Accounting Systems).

Preferred Qualifications

• Intermediate knowledge of one or more of the following Patient Accounting Systems: EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon.
• Intermediate knowledge of DDE Medicare claim system.
• Intermediate knowledge of government rules and regulations.

Pay

The salary range for this role is from $20.00 to $23.00 per hour, based on factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.