Payment Variance Auditor I
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Job Description
Remote Payment Variance Auditor reviewing healthcare claims, contracts, and reimbursement data for Savista. Identifying underpayments and trends to support healthcare revenue recovery.
Responsibilities:
- Review high-volume reports and historical payment information to determine reimbursement accuracy.
- Review hospital managed care contracts for correct application of rates, provisions, and terms.
- Identify potential underpayment trends by comparing contracts with actual reimbursement information using contract management technology.
- Apply analytical techniques to remove inaccurate information and false-positive returns.
- Investigate third-party payor policies and contracts against published payor guidelines.
- Interface with Contract Specialist team to refine contract models when discrepancies are identified.
- Verify patient benefits and eligibility to screen out denials, plan type, and demographic information that may affect underpayment trends.
- Report underpayments and trends to management and the audit team for pursuit and collection.
- Update reasons for pursuit and pursued amounts as needed.
- Meet individual and team goals for volume and value of underpayments identified.
- Support Savista’s Compliance Program by adhering to applicable policies and procedures, completing required training, reporting concerns, and handling patient information in a HIPAA-compliant manner.
Requirements:
- High school diploma or GED.
- 1-2 years of experience working with managed care reimbursement and contracts.
- Familiar with ICD-9 and ICD-10, CPT Coding, revenue codes, UB and 1500 billing formats.
- Self-motivated and independent.
- Strong analytical acumen.
- Proficiency with MS Office.
- Strong leadership skills.
- Excellent oral and written communication skills.
- Compliance with HIPAA, FDCPA, FCRA, and other applicable laws.
- Demonstrable awareness of confidentiality obligations.
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