Savista

Medical Billing and Coding

• Review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the requirements of hospital data or physician data retrieval for billing and reimbursement.
• Validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals.
• Perform documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements.
• Interact with client staff and providers.
• Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types which may include but not limited to: Ancillary (Diagnostic)/ Recurring; Hospital, Clinic; Physician Pro Fee; Technical Fee or Evaluation and Management.
• Review and analyze facility records to ensure that APC assignments and/or Evaluation and Management codes accurately reflect the diagnoses/procedures documented in the clinical record.
• Abstract clinical data from the record after documentation review to ensure that it is adequate and appropriate to support diagnoses, procedures and discharge disposition is selected.
• Complete assigned work functions utilizing appropriate resources.
• Act as a resource with client staff for data integrity, clarification and assistance in understanding and determining appropriate and compliant coding practices including provider queries.
• Maintain strict patient and provider confidentiality in compliance with all HIPAA Guidelines.
• Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.
• Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
• Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.

Profee Coder – Hospitalist

Bilingual

• Conduct advanced eligibility screening in-person
• Facilitate the application process for programs
• Act as a liaison between patients and hospital staff
• Maintain accurate and confidential records
• Identify and assist with complex cases

Eligibility Specialist 2, Bilingual Required

Billing Specialist

• Utilize various hospital/physician systems to verify patient, billing and claim information for accuracy
• Perform compliant primary/secondary, tertiary and rebill billing functions
• Edit claims to meet and satisfy billing compliance guidelines
• Respond timely to emails and telephone messages
• Communicate issues to management
• Participate and attend meetings as requested
• Update patient demographics/insurance information
• Monitor claims for missing information
• Secure needed medical documentation required by third party insurance carriers
• Maintain confidentiality of patient information
• Perform other related duties as required

Sales

• Driving new business growth and expanding existing client relationships
• Leading strategic sales initiatives for accreditation, data collection, and quality reviews
• Developing detailed sales and marketing plans, forecasts, and call plans
• Building C-suite relationships with assigned and identified accounts
• Driving decision-making integral to deal development and closing new business
• Orchestrating efforts of other business units and sales teams during the selling process

Vice President, Sales – Registry Services

• Review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types.
• Validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record.
• Perform documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements.
• Interact with client staff and providers
• Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types.
• Review and analyze facility records for accurate APC assignments and/or Evaluation and Management codes.
• Abstract clinical data from the record after documentation review.
• Maintain strict patient and provider confidentiality in compliance with all HIPAA Guidelines.
• Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.
• Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements.

Profee Coder – Neurosurgery

Auditor

• Perform audits of medical records for denials review, defense audits, disallowed charges, and utilization reviews
• Complete analysis of records against established criteria
• Determine, request, and obtain appropriate supporting documentation
• Compose appeal letters addressing both contract issues and medically related issues
• Organize and prioritize multiple cases for departmental workflow
• Enter audit findings into computer systems
• Function in a professional manner focusing on customer service

RN – Clinical Auditor 2

• Assigns either ICD-10-CM and PCS codes for inpatient visits or assigns ICD-10 CM codes, professional and technical EM levels, and surgical CPT codes for physician visits at commercially reasonable production rates and at a consistent 95% or greater quality level.
• Validates either MS-DRG or APC assignments, as applicable.
• Abstracts clinical data appropriately.
• Mitigates either hospital inpatient coding-related claims scrubber edits or professional and technical coding-related claims scrubber edits.
• Tolerates short-term assignments for up to two different clients.
• Participates in client and Savista meetings and training sessions as instructed by management.
• Maintains an ongoing current working knowledge of the coding convention in play at client assignments.
• Performs other related duties as required.

Inpatient Coding Specialist – Facility

Financial Planning and Analysis

• Process and verify administrative and financial components of financial clearance including validation of insurance benefits, medical necessity, routine and complex pre-certification, prior-authorization, scheduling and pre-registration, patient benefit and cost estimates, and pre-collection of out-of-pocket cost share.
• Obtain pre-certifications, authorizations, and referrals for upcoming appointments.
• Communicate recommended changes to schedules and care planning to ensure alignment with authorization requests and payor compliance
• Liaison between patient, insurance payors and providers to obtain prior authorization for prescheduled services
• Effectively address issues and offer information and support to both patients and physicians concerning financial clearance matters
• Process stat request prioritization
• Verify demographic information
• Apply payor changes to registration
• Verify, edit and/or remove user defined referral counts editing final status of referrals
• Edit the scheduled date within the referral, pend referrals to any pools, suppressing expiring referrals messages, accessing assigned referral work queues, defer/activate referral work queue items, use referral templates
• Apply critical thinking skills to identify and resolve problems proactively

Financial Clearance Specialist

• Travel regularly to assigned facilities and occasionally conduct in-home visits, ensuring timely and efficient support across multiple locations within the service area*
• Meet with patients in-person, including bedside visits, to assess financial assistance eligibility and provide compassionate guidance on available programs
• Facilitate the application process for programs such as Medicaid, Medicare, Disability, and hospital charity care, ensuring timely submission of accurate documentation
• Act as a liaison between patients, hospital staff, and government agencies to establish eligibility, secure funding and resolve coverage issues
• Responsible for a high caseload, prioritizing tasks to meet deadlines and ensure effective follow up on pending applications
• Clearly communicate financial obligations, funding options, and program details to patients in an empathetic and professional manner
• Maintain accurate and confidential records in compliance with HIPAA and organizational policies
• Consistently achieve productivity and quality metrics, contributing to the organization's financial counseling objectives
• Efficiently use multiple systems and databases to gather, track, and report on patient data
• Assist in training and supporting colleagues as needed, ensuring seamless onboarding and service delivery
• Complete special projects, as assigned.

Eligibility Specialist 2, Bilingual, Medical Disability Processing Experience

Customer Support

• Resolve patient healthcare accounts by negotiating payment with patients/guarantors while meeting or exceeding performance and quality objectives.
• Complete daily account related functions in an efficient and timely manner to accelerate the patient-to-payment process.
• Through both inbound and outbound calls leveraging an auto-dialer, negotiate payment plans with customers by reviewing account history.
• Maintain a 96% quality score through superior customer service and accurate documentation of customer encounters.
• Execute appropriate procedures for follow-up on third party approvals, billing, and collection of overdue accounts.
• Perform routine tasks or repetitious tasks with care and attention.
• Answer incoming patient or client call/email requests and handle in a prompt, courteous and professional manner.
• Other duties as assigned or requested by Supervisory or Managerial personnel such as acting as back up in other departments.

Customer Service Representative – Medical Self Pay

• Code complex Inpatient records for a large teaching level health system

Inpatient Coder

• The Clinical Auditor 2 performs audits of medical records on behalf of hospital clients for denials review, defense audits, disallowed charges, and utilization reviews.
• This position requires critical thinking and judgment and must demonstrate the ability to appropriately use standard criteria such as InterQual and Milliman (MCG) in addition to criteria established by state Medicaid programs or hospital policy.
• Audit and analysis must be accurate and consistently ensure a high level of quality, knowledge of laws, rules, regulations and guidelines necessary to ensure compliance and protection of information.
• Performs audits of medical records to identify and/or defend charges, including Defense Audits, Patient Inquiry Audits, Disallowed Charges, and Biller Requested Audits.
• Completes analysis of records against established criteria to determine if patient condition and/or care meets that criteria, including Avoidable day studies, Managed care, Medicare or Medicaid reconsiderations/appeals, Medicare or Medicaid RAC appeals or other specialized Audit Appeals.
• Determine, request, and obtain appropriate supporting documentation from hospital, physicians, current medical literature and patient.
• Will compose appeal letters addressing and appealing both contract issues and medically related issues.
• Organizes and prioritizes multiple cases concurrently to ensure departmental workflow and case resolution.
• Enter audit findings and/or data into Client’s computer based system.
• Proficiently utilize multiple computer based systems to complete and document work (both Savista and client).

RN, Clinical Auditor

Insurance

• Travel regularly to assigned facilities and occasionally conduct in-home visits, ensuring timely and efficient support across multiple locations within the service area.
• Meet with patients in-person, including bedside visits, to assess financial assistance eligibility and provide compassionate guidance on available programs.
• Facilitate the application process for programs such as Medicaid, Medicare, Disability, and hospital charity care, ensuring timely submission of accurate documentation.
• Act as a liaison between patients, hospital staff, and government agencies to establish eligibility, secure funding and resolve coverage issues.
• Maintain accurate and confidential records in compliance with HIPAA and organizational policies.