Complex Clinical Denials

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).

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