Senior Manager, Performance Partners
BD
Salary
💰 $28 - $40 per year
Job Level
Mid-LevelSenior
About the role
- Primary / Essential Functions: Clinical Staff Responsibilities: 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), to determine if patient condition and/or care meets that criteria, including: o Avoidable day studies o Managed care, Medicare or Medicaid reconsiderations/appeals o Medicare or Medicaid RAC appeals or other specialized Audit Appeals (e.g. CERT, ZPIC, SMRC)
- 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)
- Client based billing, Internal based billing, medical record and quality systems Microsoft Outlook, Word and Excel
- Function in a professional, efficient and positive manner Must be customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
- Will help identify issues or challenges in the department, and come up with solutions or ideas to improve
- Maintain confidentiality of patient information and abide by all HIPAA related guidelines
- Competencies: Puts Clients First Drives for Results Understands our Business Thinks Innovatively Values Differences Builds Teamwork Gains Trust Communicates Effectively Shows Accountability Takes Action Embraces Change Makes Quality Decisions
- Physical / Mental Demands, Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to use hands to finger, handle or feel, sit, stand, walk, lift up to 20 pounds, stoop, clean, bend, and reach with hands and arms. Must communicate clearly in English. Requires the ability to speak, read, write, see, and hear to perform essential duties of the job.
- Effective and positive human relations skills are required, including confidentiality, in order to appropriately interface with staff and clients. Must be able to perform multiple tasks and detailed work, problem solve, reason, and perform basic mathematical calculations. Equipment Used: Telephone, fax, calculator, computer, monitor, printer, hardware and software packages, computer peripheral equipment i.e. mouse and keyboard; and Microsoft software.
- Minimum Qualifications: 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 is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $28.00 to $40.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills. SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class. California Job Candidate Notice About Us The Savista experience is the combination of everything that’s unique about our culture, our core values, our commitment to success, but most importantly, it’s our people. Our colleagues are problem-solvers, flexible and agile trusted partners who believe in a culture based on service. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us a Certified Great Place to Work 4 years in a row! Read More Job Scam Alert It has come to our attention that there have been some bad actors using our company name to solicit personal information as part of a fraudulent hiring scam. Unfortunately, this is out of our control, but we want to make it clear that this behavior is unacceptable. All of our open roles are posted on our careers page . Should you apply for a role and be contacted by an employee of Savista, all of our interviews will be scheduled by someone with an @savistarcm.com email address and conducted over video call or in-person. We never ask you to provide personal information through other means, such as Telegram or social media platforms, as part of our interview or onboarding process. Savista does not and will not ask you to share any personally identifiable information (such as bank account details, SSN, etc) by any other means than a secure platform. We recommend you do not share any sensitive information over the phone or email. If you are offered a position, Savista does not and will not ask for payment to ship equipment. Fraudulent hiring scams often also ask for financial information and may ask for “advances.” Savista does not ask for any financial commitment at any stage of the recruitment process. We have reported and flagged these job scams when we’ve seen them. We also encourage you to contact your state attorney general’s office to report any potential scams and also recommend you contact any recruiting website and/or social media platform that may have been involved as well to notify them. Savista has no responsibility for fraudulent offers and advises job candidates to follow the guidance provided. Read More California Job Candidate Notice Privacy Policy © 2025 Workday, Inc. All rights reserved.
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
