Healthcare Operations Support Specialist (SCA) - Repricing Focus

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:

The Healthcare Operations Support Specialist-Repricing is responsible for re-pricing medical claims post audit using multiple client applications, systems, and pricing methodologies. Additional responsibilities include monitoring internal reports, taking specific actions based on available information and responding to internal inquiries regarding repricing calculations. This role will also participate in special ad hoc projects and program initiatives, as assigned.

Key Responsibilities to include:

• Appropriately process post-audit claims using different payment methodologies such as Inpatient, Outpatient, SNF, HH and DME.
• Correctly interpret billing elements of a medical claim
• Work within and operate multiple systems and applications effectively
• Effectively listen and question when necessary and show excellent attention to detail.
• Work within ICD-10-CM/PCS, CPT-4, and HCPCS coding.
• Utilize diagnostic grouper tools such as DRG, APR-DRG, EAPG, and APC.

Knowledge, Skills and Abilities Needed:

• Knowledge of Medicare/Medicaid programs; particularly payment rules.
• Strong computer skills: intermediate level experience with MS Office products including Outlook, Word, PowerPoint.
• Intermediate to advanced Microsoft Excel, and the ability to quickly develop expertise in new systems and applications.
• Ability to learn new systems and applications quickly and efficiently
• Outstanding written and verbal communication skills
• Strong listening and questioning abilities; excellent attention to detail.
• Exceptional problem-solving skills to identify solutions to complex scenarios.
• Ability to work independently but also as a member of a team.

Required and Preferred Qualifications

• High School Diploma/GED is required
• Some college, Associates or Bachelor's degree is preferred
• Health care data analysis experience including gathering and documenting requirements for projects of all sizes, is a plus.
• Experience analyzing and manipulating data using spreadsheet applications is required; experience using health care data in this way is preferred.
• Experience using Microsoft Excel and other Microsoft Office applications is required.
• Understanding of different health care payment methodologies such as Inpatient, Outpatient, SNF, HH and DME, is preferred.
• Experience with and knowledge of diagnostic grouper tools such as DRG, APR-DRG, EAPG, and APC is preferred.
• Understanding of how to interpret provider contract(s) payment methodologies, is preferred
• Team members must maintain a 95% or greater accuracy rate for the claims they are assigned. Training is provided to help ensure accuracy goals are achieved.

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