21 days old

Sr. Healthcare Billing Recovery MSP Operations Analyst GHP

Sunrise, FL 33351
Regular Full Time

The Senior Healthcare Billing Recovery MSP Operations Analyst GHP leverages solid operational Medicare Secondary Payer (MSP) and Coordination of Benefits (COB) knowledge, coupled with a broad system skills, expert Group Health Plan (GHP) healthcare billing/claims knowledge, reporting and analysis, and related subject matter skills needed to support Performants MSP and GHP operations.  This position interfaces with the MSP department operations, third-parties (clients, payers and other CMS MSP contractors), and internal information systems groups to support the correct intake and processing of GHP correspondence, and the correct adjudication of decisions on GHP demands that have been appealed by the related GHP or their authorized representative.  
Job duties include, but are not limited to:

Understands MSP GHP workflows and processes and serves as an advisor to GHP operations and other MSP CRC departments interacting with the GHP operations.  
Creates, analyzes and disseminates various trend analysis reports based upon CMS systems and Performant data systems that assist the GHP operational team in understanding the effectiveness of its operations. 
Proactively identifies potential issues, gaps, continuous improvement opportunities, or areas of concern or need.  Researches and gathers information from diverse sources and distills into succinct business cases to the manager.
Identify concerns and issues from GHPs and bring them to the GHP management teams attention.
Assist with sharing CRC related processing information with GHPs as directed by management and CMS. 
Assist in answering GHP questions regarding MSP policy and guidelines such as what is acceptable to satisfy the fee schedule requirement, required wording for timely filing defenses, requirements for eligibility and coverage letters, etc. 
Assist in the maintenance of a GHP contact list. 
Act as an internal Subject Matter Expert for how GHPs may work more effectively with the MSP CRC. 
Assist GHPs in understanding where their Section 111 reporting may be affecting the demands received from the MSP CRC. 
Supports operational initiatives and collaborates internally leveraging knowledge toward development and delivery of tools and training that disseminate information and educate applicable operations management and staff, and workflow documentation, process maps and standard operating procedures.
Develops collaborative relationships internally and externally.
Accountable for task ownership, meeting deadlines and operating maturity with minimal supervision and direction in the form of project assignments.
May lead or support various projects and activities in support of the MSP contract operations.  
May be required to work some Performant holidays due to client requirement.
Telework or work from assigned office as may be required based upon business needs in adherence with Company policies and requirements. 
Upon hire (and process facilitated by the Company through the client) obtain and maintain required government client clearances.

Perform other incidentals and related duties as required and assigned.


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:

Expert knowledge of Group Health Plans, Section 111 Reporting and these two topics interface interact with and impact the MSP CRC contract.  
Strong operational knowledge of Group Health Plans Medicare Secondary Payer operations. 
Solid knowledge of healthcare billing, claims and applicable terminology
Analytical and critical thinker with strong research skills that thrives on solving complex problems; demonstrated ability to analyze complex issues and helping others to understand where processes may need to change in order to make operations more effective. 
Demonstrated ability to apply independent judgment and good decision making skills to solve sometimes complex customer and stakeholder issues, concerns and/or complaints. 
Strong Microsoft Office suite skills; intermediate Excel
Outstanding written and verbal communication skills
Demonstrated ability to effectively build relationships, work collaboratively and influence internally across business units and functions, as well as externally with partners, stakeholders and clients. 
Ability to develop and maintain trust and credibility
Excellent attention to detail and ability to synthesize information from several different sources required to troubleshoot issues or lead assigned initiatives  
Ability to work independently with work instruction in the form of objectives with minimal oversight
Ability to deliver day-to-day support to the business with a professional attitude and exceptional organization skills under pressure
Ability to adapt to rapidly changing business requirements and applying skills in effective and innovative way to meet dynamic business needs.
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
Performs duties in a busy standard office environment with moderate noise level or may work remotely from home-office as may be required based upon business needs, in accordance with company policies & procedures.
Sits or stands at a desk during scheduled shift, reaching as needed to use office equipment.
Makes and returns 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).
Types frequently, but not constantly, using a keyboard and mouse.
Occasionally lifts/carries/pushes/pulls up to 10 pounds.
Education and Experience:
High School diploma or GED required.
Bachelor's degree or equivalent combination of education and experience.
10+ years of relevant progressive experience in healthcare operations working with Medicare Secondary Payer operations and the Coordination of Benefits demonstrating subject matter expertise applicable to the position.
2+ years in a professional level role and function demonstrating the level of technical, analytical and soft skills required for the position.  

Other Requirements:
Other Requirements:
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.
Must submit to and pass drug screen.
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.
Visa sponsorship is not available.

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: 2020-06-23 Expires: 2020-08-13
Analytics, audit, and recovery services for healthcare, government and student loans.

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Sr. Healthcare Billing Recovery MSP Operations Analyst GHP

Performant Financial
Sunrise, FL 33351

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