1+ months

Healthcare Billing Recovery Conditional Payment Notice Specialist (SCA)

Myrtle Point, OR 97458
Regular Full Time
   

Responsibilities:
Available for hire in the following locations:  Sunrise, FL. andSan Antonio, TX

The Healthcare Billing and Recovery CPN Specialist contributes to the operations teams achievement of Statement of Work (SOW) requirements for the Center for Medicare and Medicaid Systems (CMS) Medicare Secondary Payer (MSP) client contract with a focus on Conditional Payment Notices (CPNs).  Leverages healthcare billing and Medicare claim expertise, medical coding knowledge, claim review, and CMS MSP  program to optimize the selection and initiation of CPNs aligned with operational objectives. Duties include, but not limited to:

Understands and evaluates data factors that contribute to Non Group Health claim records that have the greatest opportunity for recovery for the MSP program and revenue generation for Performant, while also having the smallest impact on the volume of appropriate/applicable incoming correspondence.
Audits and analyzes details of potential CPNs by comparing specific Common Procedural Terminology (CPT) codes, Diagnosis Codes, Diagnosis Related Group (DRG) codes, etc., related to each potential CPN associated with the identified incident or injury type. 
Based upon review of the Non Group Health data in the system identifies the correct and appropriate individual pre-demand CPNs  to be selected for processing that meet the applicable criteria.  
Completes selection of appropriate CPNs for generation mailing to applicable NGHPs and/or their respective Recovery Agents.   
Tracks and reports CPNs generated on a daily, weekly and monthly basis.  Reporting may minimally include, but not be limited to, the total number of CPNs generated each day, the financial value for said CPNs and the entities for which the CPNs were generated for.  Produces reports as requested by management.
Runs reports and analyzes information to project potential and track actual correspondence generated to the CRC as a result of the selected CPNs.  Runs reports and tracks additional information as may be needed to for trending and analysis on the activity related to selected CPNs including but not limited to the associated revenue generated, processing time and related expenses, and Return on Investment (ROI).   
Responsible for meeting monthly forecasted CPN volume processing. 
Maintains current and full functionality knowledge and capability on applicable systems and Standard Operating Procedures (SOPs) for selecting and processing CPNs in order to successfully review and select CPNs in accordance with operational objectives and compliance of the program, and position purpose.  
Performs Non-Group Health Plan (NGHP) case work meeting all required production and quality standards applicable to the CRC contract/program as defined by applicable Performant Policies during periods of decline in CPN review activity and/or as directed by management to support business needs.   Responsible for reporting trends, submitting system enhancement requests, and other suggestions to enhance CPN selection process.
Other duties and assignments as required to meet business needs
Telework or work from assigned office as may be required based upon business needs in adherence with Company policies and requirements. 


*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 

 


Required Skills and Knowledge:
Demonstrated knowledge and expertise in the audit and analysis of Medicare billing and claims information. 
Medical Coding knowledge gained through certification, and/or experience in the analysis and comparison of Medicare claims data to NGHP claims information in order to determine if the Medicare program appropriately paid as the primary insurer. 
Excellent knowledge of healthcare billing, and demonstrated understanding of the relationship between health insurer based claims and non-group health claims in order to understand Payer primacy responsibilities.
Demonstrated ability to audit and analyze large volumes of data related to medical claims and billing, with distinct ability to identify coding variances and comparisons to treatment plans and incidents on non-group healthcare plans (NGHP)
Proficiency in using databases, Excel spreadsheets, and related billing data administrative platforms to accurately transfer and submit claims data, as well as prepare reports and perform data analysis .  
Previous exposure or experience in using BCRS, HIGLAS and claims processing/adjudication systems, etc., related to the Centers for Medicare Services (CMS) and Non-Group Health Plans (NGHP). 
Strong computer skills using Excel, Word, Power point, Outlook, and other Microsoft suite programs. 
Ability to effectively perform and deliver individual results, while also working cooperatively with others to promote positive team environment. 
Ability to work full-time on-site during assigned schedule and as needed to meet business needs. 
Demonstrated ability to maintain positive attitude and good judgment in fast passed dynamic environment. 
Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
Ability to follow process, procedures and regulations in the workplace.
Protected patients privacy, understands and adheres to HIPAA standards and regulations.
Mind-set of continuous improvement and adapts quickly to change.

 

Ability to obtain and maintain client requiredclearances as well as pass company regular background and/or drug screening.

Completion of Teleworker Agreement upon hire, andadherence to the Agreement (and related policies and procedures) including, butnot limited to: able to navigate computer and phone systems as a user to workremote independently using on-line resources, must have high-speed internetconnectivity, appropriate workspace able to be compliant with HIPAA, safety& ergonomics, confidentiality, and dedicated work focus withoutdistractions during work hours.

Physical Requirements: 

Available for hire Teleworking in the following arealocations:  Florida (Sunrise/BrowardCounty) & Texas (San Antonio).  Youwill add the specific locations that relate to your position in this area here

**NOTE: Must be able to meet requirements for andperform work assignments in accordance with Company policies and expectationson a home remote basis (and must meet Performant remote-worker requirements)until at which time staff may be notified and required to work from aPerformant office location on an ad-hoc or periodic basis.

Basic office equipment required to perform remote workis provided by the company.

Job is performed in a standard busy office environmentwith moderate noise level (or may be home-office setting subject to Companyapproval and Teleworker Agreement), sits at a desk during scheduled shift, usesoffice phone or headset provided by the Company for calls, making outboundcalls and answering inbound return calls using an office phone system; views acomputer 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 tostand as needed while on calls; reach as needed to use office equipment.

Consistently viewing a computer screen and typesfrequently, but not constantly, using a keyboard to update accounts.

Consistently communicates on the phone as requiredprimarily within the department and company and may include client contacts orother third-party depending on assignment with account holders, may dialmanually when need or use dialer system; headset is also provided.

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

Physical Requirements:

*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). Basic office equipment required to perform remote work is provided by the company.
Job is performed in an standard busy 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.

 


Education and Experience:
High school diploma or GED
Medical Coding Certification (preferred), or previous experience in Medical Coding analysis using up-to-date ICD-9 and/or ICD-10 Coding, and strong knowledge of service level coding systems such as CPT, HCPCS, DRGs, etc.
6+ years of experience in medical billing , with strong history specific to processing and auditing Medicare claims, demonstrating depth of knowledge and capability required for the position. 
Experience as user and administrative functionality of Benefits Coordination & Recovery System (BCRS) and the Healthcare Integrated General Ledger Accounting System (HIGLAS) strongly preferred.   



Other Requirements:

Performant is a Government contractor and subject tocompliance with client contractual and regulatory requirements, including butnot limited to, Drug Free Workplace, background requirements, and clearances(as applicable).

Must submit to and pass pre-hire background check, aswell as additional checks throughout employment.

Must be able to pass a criminal background check; mustnot have any felony convictions or specific misdemeanors, nor on state/federaldebarment or exclusion lists.

Must submit to and pass drug screen pre-employment (andthroughout employment).

Performant is a government contractor. Certain clientassignments for this position requires submission to and successful outcome ofadditional background and/or clearances throughout employment with the Company.

 Employment VISA Sponsorship is not available for thisposition

Job Profile is subject to change at any time.

EEO

Performant Financial Corporation is an Equal OpportunityEmployer.

Performant Financial Corporation is committed tocreating a diverse environment and is proud to be an equal opportunityemployer. All qualified applicants will receive consideration for employmentwithout regard to race, color, national origin, ancestry, age, religion,gender, gender identity, sexual orientation, pregnancy, age, physical or mentaldisability, genetic characteristics, medical condition, marital status,citizenship status, military service status, political belief status, or anyother consideration made unlawful by law.

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZEDAGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER5.       In the other tab this should be added after the experience andeducation section at the top of the tab (For PTI postings)





   


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Posted: 2022-01-31 Expires: 2022-06-12
Analytics, audit, and recovery services for healthcare, government and student loans.

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Healthcare Billing Recovery Conditional Payment Notice Specialist (SCA)

Performant Financial
Myrtle Point, OR 97458

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