Regular Full Time
Pay Range: -
   

Responsibilities:
A Career Opportunity for the motivated high performer looking for more than just a job!  

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 are looking for highly-skilled, talented medical billing recovery supervisor that drives results and leads by example leveraging expertise in Medical Billing Recovery, knowledge of Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP)  and procedural challenges regulations; experience generating or auditing medical  bills; proven ability to interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; and communicate effectively with liable parties to recapture payments.  Ability to train and guide Billing Recovery Case Specialists, handle escalated calls and cases; and support management with compliance, quality, program operation functions such as Insurer/Plan  outreach or case inventory assignments, and continuous improvement efforts.  Also performs supervisory functions, coaches employees for development, provides constructive feedback and disciplinary actions in conjunction with the applicable operational manager. 

As the Healthcare Billing Recovery Operations Supervisor you will be responsible for Specialists (caseworkers) performing billing and recovery services to/for Group Health Plans, Non Group Health Plans and  other related, authorized and liable parties. 

Ensure staffing and training of case specialists for assigned business 
Contribute to development and continuous improvement of operational tools, processes and procedures. 
Ensure assigned team consistently achieves established metrics and goals assigned, quality and compliance requirements.
Leads by example and demonstrates Performant core values in performance of job duties and all interactions.
Provides feedback, coaching and additional training to assigned team to correct areas of deficiency and oversight received from quality reviews and/or management, as well as performance feedback and skills development to increase capability and effectiveness of specialists.
Oversee work activities and provide guidance for case and call escalation to specialists including, but not limited to:
Review account claim and other documentation to verify payment liability for claims paid in error. 
Make outbound calls to contact liable parties regarding payment of claims; answer questions and educate liable parties on their obligation to pay. 
Effectively follow scripts, guidelines and other tools provided to have professional conversations with liable party contacts. 
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.
Update company systems with clear and accurate information 
Initiates activity based upon arrangement with liable parties; 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.
Ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
May be required to work some Performant holidays due to client requirement.
Perform other incidental and related duties as assigned to meet business needs.

 

*Notes:
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:

Demonstrated ability to lead and drive operational results in similar healthcare billing recovery or insurance claim review function.  Leverages operational reports and data to evaluate team results and identify areas for improvement. 
Develops approaches and initiates action to improve and grow employee skills and team results
Demonstrated ability to inspire and lead a team of operational staff; knowledge of best practices to successfully hire, train, coach, motivate, develop, manage performance and hold accountability of team members.
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 involving Workers Compensation, Auto Liability and other non-group health plan primary payer liabilities.
Experience with Coordination of Benefits and Medicare Secondary Payer involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties.  
Proven expertise in gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues, including Medicare and Medicaid claims.
Ability to communicate professionally and effectively with management, staff, client and vendor representatives, providers, carriers, beneficiaries and other audiences regarding claims and billing payment. 
Protects 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 and servant leadership attitude.
Ability to share knowledge and educate staff and third parties on healthcare billing and claims related terminology, procedures, and related information.
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, teach, and support improvement of process, procedures and workflow.
Ability to effectively perform deliver results, and work cooperatively with others to promote a positive team environment.
Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs.
Ability to consistently perform job responsibilities.
Possess a personality type that is ethical, friendly, hard-working and proactive.
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 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.

 

 

 

Education and Experience:
Minimum 2 years of experience as a supervisor, or lead with supervisory responsibilities, for similar function. 
Minimum 5 years of experience in medical billing experience demonstrating depth of knowledge and capability required for the position. 
Minimum 3 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills preferably in a healthcare or related industry.
High School diploma or GED required
Some college in medical terminology, billing, coding or Medical Billing/Coding certification preferred.

Other Requirements:

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

Visa sponsorship is not available.

Job Profile is subject to change at any time.

EEO 

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 ORDER

 

   


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