AR Specialist 2 – Complex Clinical Denials

🕒 May 13

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Savista

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1994

⚕️ Healthcare Insurance

Healthcare Insurance

Savista is a full-service revenue cycle management provider with over 30 years of experience in the healthcare industry. They support healthcare organizations in improving financial outcomes by offering services such as AR management, denial management, clinical documentation integrity, eligibility & enrollment, and HIM outsourcing. Savista works as an extension of healthcare teams to optimize processes and increase efficiency to ensure compliance and drive patient-centered service quality. The company has garnered recognition and industry accolades for its effective and quality solutions.

📋 Description

• 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.

🎯 Requirements

• 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.