Payment Variance Auditor I

About the role

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 and underpayment identification systems to identify potential individual underpayments and underpayment trends. Identified potential underpayments and trends will be analyzed and screened to remove false positives, enabling other team members to accurately and efficiently pursue lost revenue on behalf of Underpayment Recovery clients. The auditor must ensure that all underpayment trends are identified so as to use best practices and processes to resolve.

Underpayment Auditor I

Essential Duties & 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.
• 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.

Minimum Requirements & Competencies

• 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.