1+ months

Healthcare Billing Recovery Case Specialist (SCA) - NGHP - Non-Group Health Plans

Myrtle Point, OR 97458
Regular Full Time
   

Responsibilities:
Candidates will be recruited from two locations; Sunrise, FL and San Antonio, TX

 We are seeking highly-skilled, talented medical billing specialists with strong knowledge of medical claim billing, medical terminology and medical coding, forms UB04 and CMS 1500, Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims, and procedural challenges regulations; experience generating or auditing medical claims and billing; proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; and communicate effectively with carriers to recapture payments. 

As a Healthcare Billing Recovery Case Specialist you will work Non-Group Healthcare (NGHP) and/or Group Healthcare(GHP) Provider delinquent accounts under the CMS Medicare Secondary Payer recovery program with responsibilities to include, but not limited to:

Review account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error. 
Leverage your knowledge and expertise in medical billing/COB/MSP to 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 correct action with applicable party (health insurance carrier, auto/home/workers comp insurance carrier, or legal representative) 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.
Updates client and/or company systems with clear and accurate information such as contact and updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates as applicable.
Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
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.
Arrives to work on-time, works assigned schedule, and maintains regular good attendance. 
Follows and complies with company, departmental and client program 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, including but not limited to, production and quality.
Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and, successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.)
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.
Work overtime as may be required. 
May be required to work some Performant holidays due to client requirement.

Other Duties
Performs other duties as assigned.

Required Skills and Knowledge:
**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.

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:

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.
Familiarity with information in forms UB04 and CMS 1500
Experience with Coordination of Benefits, Third Party Liability, Medicare Secondary Payer
Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues;
Ability to communicate professionally and effectively with providers, carriers, beneficiaries and other audiences regarding claims and billing payment. 
Experience in handling Medicare and Medicaid claims.
Protected 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 attitude.
Self-motivated and thrives in a fast-paced business operations department 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, individual coaching, etc.).
Ability to follow process, procedures and regulations in the workplace.
Ability to effectively perform work independently, and work cooperatively with others to promote a positive team environment.
Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
Ability to consistently perform job responsibilities.
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 (including applicable policies and procedures), which includes, but not limited to, basic home office suitability requirements such as high-speed internet connectivity, appropriate work-space for compliance with confidentiality, HIPAA, safety and ergonomics, and work environment allowing dedicated work-focus without distraction during work hours.

 

Possess a personality type that is ethical, friendly, hard-working and proactive.


Additional Requirements:

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

Completion of Teleworker Agreement upon hire, andadherence to the Agreement (and related policies and procedures) including, butnot limited to: able to navigate computer and phone systems as a user to workremote independently using on-line resources, must have high-speed internetconnectivity, appropriate workspace able to be compliant with HIPAA, safety& ergonomics, confidentiality, and dedicated work focus withoutdistractions during work hours.

 

Physical Requirements:

Available for hire Teleworking in the following arealocations:  Florida (Sunrise/BrowardCounty) & Texas (San Antonio).  Youwill add the specific locations that relate to your position in this area here

**NOTE: Must be able to meet requirements for andperform work assignments in accordance with Company policies and expectationson a home remote basis (and must meet Performant remote-worker requirements)until at which time staff may be notified and required to work from aPerformant office location on an ad-hoc or periodic basis.

Basic office equipment required to perform remote workis provided by the company.

Job is performed in a standard busy office environmentwith moderate noise level (or may be home-office setting subject to Companyapproval and Teleworker Agreement), sits at a desk during scheduled shift, usesoffice phone or headset provided by the Company for calls, making outboundcalls and answering inbound return calls using an office phone system; views acomputer 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 tostand as needed while on calls; reach as needed to use office equipment.

Consistently viewing a computer screen and typesfrequently, but not constantly, using a keyboard to update accounts.

Consistently communicates on the phone as requiredprimarily within the department and company and may include client contacts orother third-party depending on assignment with account holders, may dialmanually when need or use dialer system; headset is also provided.

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


Education and Experience:
Experience and Education:

Minimum 6 months of medical billing experience, including Medicare, demonstrating depth of knowledge and capability required for the position. 
Minimum 2 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills.
High School diploma or GED

Other Requirements:

Performant is a Government contractor and subject tocompliance with client contractual and regulatory requirements, including butnot limited to, Drug Free Workplace, background requirements, and clearances(as applicable).

Must submit to and pass pre-hire background check, aswell as additional checks throughout employment.

Must be able to pass a criminal background check; mustnot have any felony convictions or specific misdemeanors, nor on state/federaldebarment or exclusion lists.

Must submit to and pass drug screen pre-employment (andthroughout employment).

Performant is a government contractor. Certain clientassignments for this position requires submission to and successful outcome ofadditional background and/or clearances throughout employment with the Company.

 

Employment VISA Sponsorship is not available for thisposition

 Job Profile is subject to change at any time.

 EEO - Performant Financial Corporation is an Equal OpportunityEmployer.

Performant Financial Corporation is committed tocreating a diverse environment and is proud to be an equal opportunityemployer. All qualified applicants will receive consideration for employmentwithout regard to race, color, national origin, ancestry, age, religion,gender, gender identity, sexual orientation, pregnancy, age, physical or mentaldisability, genetic characteristics, medical condition, marital status,citizenship status, military service status, political belief status, or anyother consideration made unlawful by law.

 

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZEDAGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER5.
   


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Posted: 2022-04-11 Expires: 2022-06-26
Analytics, audit, and recovery services for healthcare, government and student loans.

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Healthcare Billing Recovery Case Specialist (SCA) - NGHP - Non-Group Health Plans

Performant Financial
Myrtle Point, OR 97458

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