Regular Full Time
Pay Range: 77350.00-104650.00
   

Responsibilities:

The Healthcare Services Issue Support Specialist Government Programs provides support to assigned Segment Specialists by maintaining current Healthcare Payment Integrity audit issues as well as provide support for the development process of new audit issues performing the following essential duties:

• Review and update of existing issues 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).
• Collaborate with Education team to develop or update training material(s) as necessary for regulatory and/or coding changes to existing issues or development of new issue training content.
• Conduct independent citation research, identify impact on new or existing issues, and document accordingly.
• Provide support to Segment Specialist related to policy, regulatory, and/or coding research with interpretation related to issues.
• Support activities required to package issues, 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 CMS issues are well formulated for client offerings (Data Mining vs Complex)
• Manage progress and track multiple tasks within multiple workflows for audit issue maintenance with high degree of accuracy and quality providing status reports and deliver results on-time.
• Serves as back-up to Segment Specialists.
• Provides written response for client or provider representatives as necessary.
• Provides support for calls with providers or client representatives as necessary.
• Contribute to evaluation of existing audit guidelines; provide recommendations to improve finding rate, reduce dispute/appeal rate, and decrease overturn rates.
• Participates in and supports statistical analysis to drive scoring/selection for new or existing audit issues.
• Collaborates with other team members to ensure on time project deliveries and knowledge transfer while maintaining required quality and productivity standards.
• Performs other duties as assigned to meet business needs.

*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:

• 2-4 years of Healthcare Payment Integrity audit experience.
• RN licensure or CPC, COC, CCS or CIC certification preferred.
• Demonstrated knowledge of applicable Medicare policy and claims process, and ability to research and analyze the same, to successfully perform the job.
• In-depth knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding.
• Knowledge of current national coding standards, particularly payment rules.
• Knowledge of Medicare claims processing systems.
• Ability to understand and apply complex policies, procedures, regulations, and legal statutes.
• Excellent organization, coordination, and administrative skills.
• 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.
• Strong critical thinking, questioning, and listening skills, with 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.
• Must be able to independently use standard office computer and other technology for working remotely and have experience using a platform to review and document findings.

Additional Requirements:

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.

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) until at which time staff may be notified and required to work from a Performant office location on an ad-hoc or periodic basis.

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

Job is performed in a 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:

Other Requirements:

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 clearances (as applicable).

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

Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.

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

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

Employment VISA Sponsorship is not available for this position.

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.

 

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZED AGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDERS.

   


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