Healthcare Services Segment Specialist (RAC)

ABOUT PERFORMANT:

At Performant, we're focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most - quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture - then Performant is the place for you!

ABOUT THE OPPORTUNITY:

The Healthcare Services Segment Specialist applies specific subject matter expertise in Payment Integrity to support of audit business activity performing the following essential duties:

Key Responsibilities

• Responsible and leads reviews, ensures updates of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly).

• Ensure training material updates (may develop or coordinate) as necessary for changes to existing concepts. - Contributes to development of training materials and tools for new concepts.

• Conduct research, identify impact on existing concepts, and document accordingly for new concept development

• Interpret and apply client policy in existing concept review/updates

• Responsible for responding to client inquiries and providing support to client services with client presentations

• Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit; CMS vs Medicaid vs Commercial)

• Responsible for monitoring and providing statistical analysis to drive scoring and selection for new and existing audit concepts.

• Responsible for the monitoring of concept performance.

• Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance with high degree of accuracy and quality providing status reports and deliver results on-time.

• Responsible for QA management of all client concepts ensuring compliance with regulatory, coding, or citation changes and are applied to concepts timely.

• Stay informed of payment integrity policy and current trends.

• Provides oversight of SME team members to ensure on time project deliveries, cross train, and knowledge transfer, and maintain required quality and productivity standards.

• Performs other duties as assigned and required to meet business needs.

Knowledge, Skills and Abilities Needed

• Demonstrates expertise (depth and breadth) of knowledge of payment integrity elements. Examples include: ICD-10-CM, ICD-10-PCS, CPT, HCPCS, or HIPPS codingand MS-DRG, APR-DRG, APC, APG, PDPM, or PDGM payment methodologies

• Strong people skills: ability to communicate with all levels within the organization, with diverse teams as well with external customers.

• Exceptional written and verbal communication skills.

• Strong attention to detail.

• Excellent critical thinking and analytical skills.

• Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames.

• Ability to work independently and in a remote environment.

• Strong Microsoft suite skills, such as - Excel, Word, Outlook and SharePoint.

Required and Preferred Qualifications

• Minimum 8+ years of progressive experience in healthcare claim type subject matter specialty specific to the position.

• Bachelor's degree in related field or equivalent experience

• Registered Nurse or Certified Coder holding nationally recognized credentials (RHIA, RHIT, AHIMA, AAPC, etc.) required

• A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology.

• Progressive health care data analysis experience including gathering and documenting requirements for projects of diverse sizes.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Performant's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant's Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED