22 days old

Healthcare Billing Recovery Case Specialist Lead

Sunrise, FL 33351
Regular Full Time
   

Responsibilities:
Performant is a market leader that delivers analytics, audit and recovery services for healthcare, government and student loans.  Were more than brick and mortar we are about helping people. Its a dynamic, fast-paced and fun workplace like a start-up, but with the backing of a profitable public company with a history of growth.

We have a great opportunity for a motivated high performer with demonstrated ability to apply strong medical billing and recovery experience, proven knowledge of Medicare, Coordination of Billing and Third Party Liability (COB/TPL), interpreting Explanation of Benefits (EOB) to resolve medical billing issues,  and also leverage good leadership skills to support team members to resolve complex case issues, reinforce training, support outreach and quality activities, and support the overall success of a team. 

As a Healthcare Billing Recovery Case Specialist Lead, you will be assigned Group Healthcare Provider delinquent accounts under the CMS Medicare Secondary Payer recovery program to review and initiate appropriate action in accordance with procedures, as well as serve as a role model, handle escalated case or process issues, reinforce training, support QA and provider/plan outreach workflow and activity in support of the team and department.

Review account claim and other documentation to verify payment liability. 
Make outbound calls to contact Healthcare Insurance carriers regarding payment of claims; answer questions and educate Healthcare Insurance carriers on their obligation to pay. 
Effectively follow scripts, guidelines and other tools provided to have professional conversations with Insurance carrier contacts. 
Leverage your knowledge and expertise in medical billing/COB/MSP to review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action.
Initiate applicable action and documentation based upon payment option, actions required if new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.
Updates company systems with clear and accurate information such as contact and updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates as applicable.
Initiates activity based upon arrangement with carrier; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
Escalates accounts for Nurse Case Worker review as appropriate for complex claims.
Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.
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.
Work overtime as may be required. 
May be required to work some Performant holidays due to client requirement.
Perform case activity audits and provide audit reports for assigned team to management. Help identify trends of audit findings, root causes, and solutions
Lead by example and demonstrates knowledge and expertise in carrying out scope of responsibilities through achieving excellent performance results, as well as compliance, attendance and behavior
Provides support to team members by providing answers to questions, as well as handles escalation from team members and complex cases 
Proactively supports research, analysis and resolution of questions and issues that arise or as assigned by management
Assist management in developing tools and/or communicating changes in requirements, systems, processes and procedures, as well as supports transition and adaptation by the team in a positive and effective manner
Review team and individual productivity and established metrics and identify potential issues and recommendations to applicable in-line supervisory or management staff
Participates in plan/provider outreach activity, inventory assignment for specific case activities, and serve as point of coordination for one or more areas of operational functions in support of the broader department. 
Support client audits and other projects as assigned by management
Performs other duties as assigned.

*Note - 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 Performants policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
Required Skills and Knowledge:


To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Below are representative of the knowledge, skills, and abilities required:

Knowledge and experience with medical claim billing procedures, medical terminology and medical coding, preferably in a role generating, auditing, recovery and/or researching the same.
Familiarity with information in forms UB04 and CMS 1500
Experience with Coordination of Benefits, Third Party Liability, Medicare Secondary Payer
Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues;
Ability to communicate professionally and effectively with providers, carriers, beneficiaries and other audiences regarding claims and billing payment. 
Experience in handling Medicare and Medicaid claims.
Protected patients privacy, understands and adheres to HIPAA standards and regulations. 
Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude.
Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, etc.).
Ability to follow process, procedures and regulations in the workplace.
Ability to effectively perform work independently, and work cooperatively with others to promote a positive team environment.
Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes; and assists other to do so in a positive manner
Strong interpersonal skills
Demonstrated ability to serve as a positive role model for other operations staff
Ability to effectively share information and train others for better results
Ability to respond to inquiries and provide constructive feedback effectively
Strong verbal and written communication skills; including excellent phone and email etiquette
Strong problem-solving skills
Ability to maintain professionalism and composure in difficult interactions or conflict
Ability to successfully perform function with minimum supervision
Applies good judgment and decision making 

Ability to consistently perform job responsibilities.
Possess a personality type that is ethical, friendly, hard-working and proactive.
-Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

***NOTE: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.
-Job is in a busy standard  is performed in an office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by the Company for 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 mouse.
-Reads and comprehends information in electronic (computer) or paper form (written/printed). 
-Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment.
-Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts.
-Consistently communicates on the phone as required primarily within the department and company and may include client contacts or other third-party depending on assignment with account holders, may dial manually when need or use dialer system; headset is also provided.
-Occasionally lift/carry/push/pull up to 10lbs.

Physical Requirements
Job is in a busy standard office environment with moderate noise level, sits at a desk during scheduled shift, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a mouse. Reads and comprehends information in electronic (computer) or paper form (written/printed).
Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment
Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts
Consistently communicates on the phone with account holders, may dial manually when need or use dialer system; head-set is also provided
Occasionally lift/carry/push/pull up to 10lbs.

 


Education and Experience:
Minimum 4+ years of medical billing experience, including Medicare, demonstrating depth of knowledge and capability required for the position. 
Some experience in leadership capacity for functional area or serve as subject matter expert, trainer or other scope with responsibility for supporting and contributing to the success of others on the team. 
High School diploma or GED

Other Requirements

Must submit to and pass background check. Must not have any Federal or State liens resulting from County, State or Federal tax issues.  Must not have any current defaulted student loans.
Must be able to pass a criminal background checks; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment lists.
Must submit to and pass drug screen.
Performant is a government contractor. Certain client assignments for this position may require additional background and/or clearances.


Job Profile is subject to change at any time.


Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation 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.

 


   


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Posted: 2020-11-06 Expires: 2020-12-27
Analytics, audit, and recovery services for healthcare, government and student loans.

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Healthcare Billing Recovery Case Specialist Lead

Performant Financial
Sunrise, FL 33351

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