Healthcare Billing Recovery Analyst

ABOUT PERFORMANT:

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

ABOUT THE OPPORTUNITY:

As a Healthcare Billing Recovery Analyst, you will be assigned a Provider portfolio and be tasked with managing it from a Recovery standpoint. In this role you will have the opportunity to leverage your well-versed background in Coordination of Benefits as well as Medicare/Medicaid and procedural challenges/regulations, and experience in generating outbound communications to Providers, with proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues.

Key Responsibilities

• Engage in Outbound recovery calls, to Healthcare Carriers and Providers regarding improperly paid claims

• Decision Support- Ability to accurately review supporting documentation provided to Performant, by Providers/Carriers to determine accuracy of finding or overpayment allegation, for Complex appeals and disputes.

• Maintain current knowledge in Medicare and Medicaid practices and regulatory issues that may affect our clients.

• Leverage your knowledge and expertise to research Overpayments and answer questions and/or provide information that will bring to successful resolution and payment.

• Educate Healthcare providers/carriers on their obligation to pay.

• Ability to analyze and understand written communication from insurance companies including explanation of benefits.

• Support internal groups or functions with gathering and interpretation of the billing and collections work to development with knowledge base and understanding of key concepts and terminology in healthcare billing and claims.

• Leverages existing excel skills to create Provider centric reporting on demand, or at Managements request.

• Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance providers

• Efficiently and diligently work through assigned inventories to meet productivity metrics assigned by management

• Ability to maintain and function in multiple client systems and environments at one time.

• Updates company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, payment commitments, as well as account status updates as applicable.

• Updates company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, payment commitments, as well as account status updates as applicable.

• Arrives to work on-time, works assigned schedule, and maintains regular attendance

• Follows and complies with company and departmental policies, processes and procedures

• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations

• Successfully completes, retains, applies and adheres to content in required training as assigned.

• Consistently achieve or exceed established metrics and goals assigned

• Demonstrates Performant core values in performance of job duties and all interactions

• Correct areas of deficiency and oversight received from quality reviews and/or management.

Knowledge, Skills and Abilities Needed

• Ability to demonstrate, strong written and verbal communication skills

• Basic understanding of revenue cycle management or Medical recovery.

• Strong knowledge and material experience with Healthcare, Medical terminology, Coding, Billing. Preferably a role in recovery or revenue cycle management.

• Demonstrates knowledge in post-payment recovery.

• Demonstrates the ability to solve complex Provider or Carrier billing questions, that assist in the resolution and understanding of the overpayment.

• Communicates effectively with Providers and Carriers to answer any questions and/or provide information that will bring successful payment or other resolution to the account.

• Demonstrated expertise in Medicare and Medicaid plans policy and procedure

• Up to date knowledge in Medicare/Medicaid appeal processing

• Knowledge in Coordination or benefits (COB)

• Demonstrates a high degree of critical thinking and analytical accuracy required to be successful.

• Proven ability to gather and interpret explanation of benefits (EOB) and answer questions and resolve standard as well as complex issues with payments.

• Strong skills using standard office technology; Computer, various applications and navigation of on-line tools and resources.

• Intermediary to Advanced excel skills.

• Applies knowledge learned in training

• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.

• Must have the availability to communicate via phone with Providers and or Carriers in a quiet space 5+ hours daily.
   

Required and Preferred Qualifications

• Bachelor’s degree in relevant field or equivalent combination of education and experience.  Significant experience along with a high school diploma, may also be considered in lieu of a completed degree.

• At least 3 years directly relevant professional working experience in a highly analytic or Recovery role.

• Experience in Healthcare Billing and/or Coding is required

• Knowledge or experience with Healthcare, Coordination of benefits or Revenue cycle management, and the like.

• Other requirements may apply

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required.  Proof of such may be required prior to an offer being made.  It is the Employee’s responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone 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 computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

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

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 other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions).   Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

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 Performant’s policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant’s Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant 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.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED