Clinical Auditor, Level 2

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November 5

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Savista

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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.

1001 - 5000 employees

Founded 1994

⚕️ Healthcare Insurance

📋 Description

• Performs audits of medical records to identify and/or defend charges, including: • o Defense Audits • o Patient Inquiry Audits • o Disallowed Charges • o Biller Requested Audits • Completes analysis of records against established criteria, (e.g., InterQual, MCG, Medicare, Medicaid criteria) • Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and patient • Compose appeal letters addressing and appealing both contract issues and medically related issues • Organize and prioritize multiple cases concurrently to ensure departmental workflow and case resolution • Enter audit findings and/or data into Client’s computer based system • Function in a professional, efficient and positive manner • Maintain confidentiality of patient information and abide by all HIPAA related guidelines

🎯 Requirements

• RN/Case Management /Utilization Review/Coding or clinical certification with a BS/BA preferred otherwise equivalent years of technical experience • 3 to 5 years of clinical experience or 3 to 5 years of clinical auditing experience in either case management, Medicare appeals, utilization review or denials management • Knowledge of Milliman (MCG) or InterQual criteria preferred • Experience in medical records review, claims processing or utilization/case management in a clinical practice or managed care organization • Fundamental knowledge of Medicare/Medicaid Guidelines • Proficiency in navigating the internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling) • Skilled with Microsoft Outlook, Word, Excel and EMR Savista

🏖️ Benefits

• Savista is an Equal Opportunity Employer • Professional development opportunities