Performant Corp

The Healthcare Services Concept Specialist supports Segment Specialists by maintaining and developing audit concepts, particularly in the MolDX space. Responsibilities include reviewing existing concepts, collaborating with specialists, and ensuring timely project deliveries. | Candidates should have at least 2-4 years of audit or payment integrity experience, along with relevant certifications such as CPC, COC, RHIA, or RHIT, and/or an RN qualification. A strong background in claims auditing and molecular diagnostics is essential. | 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: Hiring Range: $90,000 - $105,000 The Healthcare Services Concept Specialist provides support to assigned Segment Specialists by maintaining current audit concepts as well as provide support for the development process of new audit concepts. This opening will be focused on creating audit concepts within the MolDX space. Ideal candidates will have at least 10 years of experience in molecular diagnostics and a strong background in claims auditing. Key Responsibilities: Responsible for the review and update 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). Collaborates with and leverages Segment Specialist expertise to ensure on-point results. Ensure training material updates (may develop or coordinate) as necessary for changes to existing concepts. -May contribute to development of training materials and tools for new concepts. Conduct research, identify impact on existing concepts, and document accordingly (may support Segment specialists with research for new concepts). Interpret and apply policy in existing concept review/updates or ask may be requested in support of Segment Specialists for new concepts. Support activities required to “package” concepts, including, but not limited to, pulling together necessary documents, and supporting data in appropriate order and locations, coordinating activities and documenting process steps, proofing documents, and tracking/reporting status. Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial) 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. May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims, as necessary. Stay abreast of industry policy. Works very closely with other 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 & Abilities Needed: Demonstrated knowledge of applicable Medicare and Commercial policy and claims process, and ability to research and analyze the same, to successfully perform the job. Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding. Knowledge of the national coding standards, particularly payment rules. Knowledge of Medicare and commercial claims processing systems. Ability to understand and apply complex policies, procedures, regulations, and legal statutes. Strong verbal communication and interpersonal skills; ability to communicate with all levels within the organization and with diverse teams. Excellent written communication skills; including proofing and editing. Good critical thinking, analytical, questioning, and listening skills; excellent attention to detail. Flexibility to handle non-standard situations as they arise; and adaptable to changing business needs in a fast-paced dynamic environment. Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames. Strong proficiency in Microsoft Word, Excel, SharePoint (advanced skills highly desirable), and easily learns and adapts to new applications and systems. Required & Preferred Qualifications: At least 2-4 years of audit or Payment Integrity experience. CPC, COC, RHIA, or RHIT certification and/or RN. 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 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. Performant is a remote-first employer, meaning the majority of our opportunities will be fully remote. However, we do offer some on-site and hybrid opportunities for those who may prefer an in-person role, and those opportunities will be identified in their respective posting details. Whether working remote, hybrid or on-site full-time, we know you will find Performant to be a collaborative organization with a focus on People, Innovation, Integrity, Fun, and fostering an Ownership Culture – we’re sure you’ll feel at home here! Introduce Yourself! If you cannot find a suitable opportunity among our posted jobs, please consider submitting your resume to become part of our Talent Community! Want information about Performant benefits? Please visit this site to see more about our benefits!

The Healthcare Services Segment Specialist leads reviews and updates existing concepts based on client or regulatory changes. They are responsible for ensuring audit concepts are well formulated and for monitoring concept performance. | Candidates must have a minimum of 8 years of progressive experience in healthcare claim specialties and a bachelor's degree or equivalent experience. Registered Nurse or Certified Coder credentials are required, along with a broad knowledge of medical claims billing and payment systems. | 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: Hiring Range: 100,000 - 115,000 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 coding and 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 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. Performant is a remote-first employer, meaning the majority of our opportunities will be fully remote. However, we do offer some on-site and hybrid opportunities for those who may prefer an in-person role, and those opportunities will be identified in their respective posting details. Whether working remote, hybrid or on-site full-time, we know you will find Performant to be a collaborative organization with a focus on People, Innovation, Integrity, Fun, and fostering an Ownership Culture – we’re sure you’ll feel at home here! Introduce Yourself! If you cannot find a suitable opportunity among our posted jobs, please consider submitting your resume to become part of our Talent Community! Want information about Performant benefits? Please visit this site to see more about our benefits!

As a Healthcare Billing Recovery Analyst, you will manage a Provider portfolio focusing on recovery efforts. This includes engaging in outbound recovery calls, reviewing documentation for accuracy, and educating healthcare providers on their payment obligations. | Candidates should have at least 3 years of relevant experience in a highly analytic or recovery role, with a strong background in healthcare billing and coding. A bachelor's degree or equivalent experience is preferred. | 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: Hiring Range: $23.00 Job Description As a Healthcare Billing Recovery Analyst, you will be assigned a Provider portfolio and be tasked with managing it from a Recovery standpoint. In this role you will have the opportunity to leverage your well-versed background in Coordination of Benefits as well as Medicare/Medicaid and procedural challenges/regulations, and experience in generating outbound communications to Providers, with proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues. Key Responsibilities Engage in Outbound recovery calls, to Healthcare Carriers and Providers regarding improperly paid claims Decision Support- Ability to accurately review supporting documentation provided to Performant, by Providers/Carriers to determine accuracy of finding or overpayment allegation, for Complex appeals and disputes. Maintain current knowledge in Medicare and Medicaid practices and regulatory issues that may affect our clients. Leverage your knowledge and expertise to research Overpayments and answer questions and/or provide information that will bring to successful resolution and payment. Educate Healthcare providers/carriers on their obligation to pay. Ability to analyze and understand written communication from insurance companies including explanation of benefits. Support internal groups or functions with gathering and interpretation of the billing and collections work to development with knowledge base and understanding of key concepts and terminology in healthcare billing and claims. Leverages existing excel skills to create Provider centric reporting on demand, or at Managements request. Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance providers Efficiently and diligently work through assigned inventories to meet productivity metrics assigned by management Ability to maintain and function in multiple client systems and environments at one time. Updates company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, payment commitments, as well as account status updates as applicable. Updates company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, payment commitments, as well as account status updates as applicable. Arrives to work on-time, works assigned schedule, and maintains regular attendance Follows and complies with company and departmental policies, processes and procedures Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations Successfully completes, retains, applies and adheres to content in required training as assigned. Consistently achieve or exceed established metrics and goals assigned Demonstrates Performant core values in performance of job duties and all interactions Correct areas of deficiency and oversight received from quality reviews and/or management. Knowledge, Skills and Abilities Needed Ability to demonstrate, strong written and verbal communication skills Basic understanding of revenue cycle management or Medical recovery. Strong knowledge and material experience with Healthcare, Medical terminology, Coding, Billing. Preferably a role in recovery or revenue cycle management. Demonstrates knowledge in post-payment recovery. Demonstrates the ability to solve complex Provider or Carrier billing questions, that assist in the resolution and understanding of the overpayment. Communicates effectively with Providers and Carriers to answer any questions and/or provide information that will bring successful payment or other resolution to the account. Demonstrated expertise in Medicare and Medicaid plans policy and procedure Up to date knowledge in Medicare/Medicaid appeal processing Knowledge in Coordination or benefits (COB) Demonstrates a high degree of critical thinking and analytical accuracy required to be successful. Proven ability to gather and interpret explanation of benefits (EOB) and answer questions and resolve standard as well as complex issues with payments. Strong skills using standard office technology; Computer, various applications and navigation of on-line tools and resources. Intermediary to Advanced excel skills. Applies knowledge learned in training Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail. Must have the availability to communicate via phone with Providers and or Carriers in a quiet space 5+ hours daily. Required and Preferred Qualifications Bachelor’s degree in relevant field or equivalent combination of education and experience. Significant experience along with a high school diploma, may also be considered in lieu of a completed degree. At least 3 years directly relevant professional working experience in a highly analytic or Recovery role. Experience in Healthcare Billing and/or Coding is required Knowledge or experience with Healthcare, Coordination of benefits or Revenue cycle management, and the like. Other requirements may apply 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 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. Performant is a remote-first employer, meaning the majority of our opportunities will be fully remote. However, we do offer some on-site and hybrid opportunities for those who may prefer an in-person role, and those opportunities will be identified in their respective posting details. Whether working remote, hybrid or on-site full-time, we know you will find Performant to be a collaborative organization with a focus on People, Innovation, Integrity, Fun, and fostering an Ownership Culture – we’re sure you’ll feel at home here! Introduce Yourself! If you cannot find a suitable opportunity among our posted jobs, please consider submitting your resume to become part of our Talent Community! Want information about Performant benefits? Please visit this site to see more about our benefits!

Provide professional and timely responses to Medicare and provider inquiries via phone, written, and electronic communications, maintaining accurate records and escalating issues as needed. | At least two years of call center or customer service experience, high school diploma or GED, HIPAA certification, and ability to learn CMS Recovery Audit Contractor program rules. | 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: Hiring Range: $18.41/Hour As a Healthcare Customer Service Specialist II (SCA) you will work within a team and be the primary point of contact for all providers, Medicare contractors, etc. This position provides professional, accurate and timely responses to CMS (Medicare) and provider inquiries. This includes responding to written, telephonic, and electronic inquiries within the appropriate timeframes. Applicants will be recruited only from Tom Green County, TX. Key Responsibilities: • Maintain a current knowledge of all contract requirements and objectives. • Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors. • Take inbound calls from providers to answer questions and resolve complex issues. • Make outbound calls to healthcare providers as a courtesy to confirm if letters requesting records for review have been received. • Respond to assigned written communications from providers timely and accurately. • Educate providers on proper process protocols and their appeal rights. • Establish appropriate contacts and perform necessary research to validate provider contact information. • Conduct critical due diligence follow-ups if additional research or action is required to resolve an inquiry. • Enter and update all contact and activity information into tracking logs and the audit platform where not automatically completed by the system, e.g., a telephone call, correspondence responses, special notes, etc. • Research and route internal/external communications to the appropriate person or department • Notify management of: • all escalated displeasure with the audit program • legal action • government intervention • escalated concerns regarding audit issues and edit parameters. • suggestions to improve or correct processes or documents. • Perform miscellaneous duties as assigned in a highly professional manner. Knowledge, Skills, and Abilities Needed: • Excellent verbal and written communication skills • Skilled in data entry and knowledge of computers • Working knowledge of Excel • Courteous, professional, and respectful attitude • Strong understanding of customer service policies and processes • Ability to learn CMS rules and regulations and understand the CMS Recovery Audit Contractor program. • Healthcare and insurance terminology knowledge preferred but not required. • Flexibility to prioritize and handle non-standard situations that may arise. • Must be detailed, organized and able to manage various job duties as required. • Maintain a strong work ethic and attendance. Required and Preferred Qualifications: • At least two years’ experience in a call center or customer service position required. • At least one year claims processing/billing experience preferred. • High School diploma or GED is required. • Must maintain HIPAA Certification. 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