Payment Variance Auditor I

This is a fully remote position, open to applicants in United States.

📋 Description

• Analyze a large volume of reports and historical payment data to assess reimbursement accuracy.

• Examine hospital managed care agreements to ensure accurate application of rates, provisions, and terms.

• Detect potential underpayment patterns by comparing contracts with actual reimbursement data utilizing contract management technology.

• Employ analytical methods to eliminate inaccurate data and false-positive returns.

• Research third-party payor policies and contracts in relation to published payor guidelines.

• Collaborate with the Contract Specialist team to enhance contract models when discrepancies are found.

• Confirm patient benefits and eligibility to filter out denials, plan types, and demographic details that may influence underpayment patterns.

• Document underpayments and trends for management and the audit team to facilitate pursuit and collection.

• Revise reasons for pursuit and amounts being pursued as necessary.

• Achieve individual and team objectives for the volume and value of identified underpayments.

• Contribute to Savista’s Compliance Program by following relevant policies and procedures, completing mandatory training, reporting issues, and managing patient information in compliance with HIPAA regulations.

⛳️ Requirements

• A high school diploma or GED is required.

• 1-2 years of experience in managed care reimbursement and contracts is preferred.

• Familiarity with ICD-9 and ICD-10, CPT Coding, revenue codes, UB, and 1500 billing formats.

• Self-driven and capable of working independently.

• Strong analytical skills are essential.

• Proficient in MS Office applications.

• Demonstrated leadership abilities.

• Excellent verbal and written communication skills are required.

• Compliance with HIPAA, FDCPA, FCRA, and other relevant regulations is mandatory.

• Clear understanding of confidentiality obligations is essential.

🏝️ Benefits

• Competitive salary.

• Opportunities for professional development.

• Health and wellness programs.

• Flexible work environment.