1+ months

Healthcare Services Segment Specialist - OutPatient

Myrtle Point, OR 97458
Regular Full Time

The Healthcare Services Segment Specialist applies specific subject matter expertise in Outpatient (OP) Coding to support of audit business activity performing the following essential duties:

-Support the responses to provider/client representative from written inquiries as it pertains to audited Outpatient claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of Performant to review audited Outpatient claims, as necessary
-Support strategic OP Coding auditing market development by attending sales meetings and other industry specific events.
-Provide leadership of OP Coding auditing strategy as per each unique contract.
-Be able to QA and probe OP Coding audit concept request after submitting to analytics team and determine if the language of the concept was converted correctly to pull correct claims for review.
-Explain to audit team what outpatient coding concept was created and how to review claims that are pulled from that concept. 
-Review audit concepts & help determine alignment/adjustment according to line of business and client policy
-Evaluate existing audit guidelines and make recommendations to improve finding rate, reduce dispute/appeal rate and decrease overturn rate
-Develop or rewrite review guidelines, as necessary
-Develop and conduct and/or support training of analytic, audit and clinical staff as necessary
-Identify, interpret and apply policy in concept development or program consultation. Stay abreast of industry policy
-Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial)
-Participate in and support statistical analysis to drive scoring and selection for new audit concepts
-Support the responses to provider/client representative from written inquiries as it pertains to audited claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of  Performant to review audited claims, as necessary
-Works very closely with other team members to ensure on time project deliveries. 
-Performs other duties as assigned and required to meet business needs.

*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:
- Demonstrated expertise (depth and breadth) of knowledge of Outpatient claims such as ICD-10, CPT and HCPCS codes.
- Strong interpersonal skills; ability to communicate with all levels within the organization and with diverse teams
- Excellent written and verbal communication skills
- Good critical thinking, questioning, and listening skills; excellent attention to detail.
- Strong critical thinking and analytical skills.
- Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames.
- Strong Microsoft suite skills, such as Excel, Word, Outlook and SharePoint. 


Additional Requirments:

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:

Bachelor's degree in related field or equivalent experience
Must have OP coding experience
RN license a plus
Outpatient Coding Certificate a plus
Minimum 8+ years of progressive experience in healthcare claim type subject matter specialty specific to the position must have created concepts for healthcare audits in relation to outpatient claims.
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 all sizes


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. 


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Posted: 2021-12-13 Expires: 2022-07-27
Analytics, audit, and recovery services for healthcare, government and student loans.

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Healthcare Services Segment Specialist - OutPatient

Performant Financial
Myrtle Point, OR 97458

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