AR Specialist 2, 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).

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

2-3 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.

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 (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

Preferred Requirements & Competencies

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

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 $20.00 to $23.00. 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.

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.

California Job Candidate Notice

Originally posted on Himalayas