Payment Variance Auditor I

Savista•Remote - TX, TX

15d•$43,870 - $50,000

About The Position

At Savista, this position supports healthcare clients by reviewing claims, payment information, and underpayment identification systems to identify potential individual underpayments and trends. The auditor analyzes and screens findings to remove false positives so other team members can efficiently pursue lost revenue for Underpayment Recovery clients. The role is responsible for identifying underpayment trends and applying best practices and processes to resolve them. The position also supports Savista’s Compliance Program by following applicable policies and procedures, including those relating to HIPAA, FDCPA, FCRA, and other laws applicable to Savista’s business practices. This includes becoming familiar with the Code of Ethics, attending required training, reporting compliance concerns or incidents, handling patient information in a HIPAA-compliant manner, and maintaining confidentiality.

Requirements

High school diploma or GED.
1–2 years of experience working with managed care reimbursement and contracts.
Familiarity with ICD-9 and ICD-10, CPT coding, revenue codes, and UB and 1500 billing formats.
Self-motivated and able to work independently.
Strong analytical acumen.
Proficiency with MS Office.
Strong leadership skills.
Excellent oral and written communication skills.

Responsibilities

Review high-volume reports and historical payment information to determine reimbursement accuracy.
Review hospital managed care contracts to determine appropriate application of rates, provisions, and terms.
Identify potential underpayment trends by comparing managed care contracts with actual reimbursement information using contract management technology.
Apply analytical techniques to reports to remove inaccurate information and potential false positives.
Investigate third-party payor policies and contracts and verify underpayment variances against published payor guidelines.
Work with the Contract Specialist team to refine contract models when discrepancies are identified.
Use available resources to verify patient benefits and eligibility and screen out denials, plan type, and demographic information that could affect the accuracy of identified trends.
Report underpayments and trends to management and the audit team for pursuit and collection.
Update pursuit reasons and pursued amounts when necessary to reflect current information.
Communicate effectively, build relationships, negotiate, solicit feedback, and respond to constructive criticism.
Meet established individual and team goals for the volume and value of identified underpayments.
Support Savista’s Compliance Program by following relevant policies and procedures, completing required training, reporting concerns or incidents, handling patient information in a HIPAA-compliant manner, and protecting confidential information.