1+ months

Healthcare Services Concept Support Specialist (Outpatient SME) - Remote

Myrtle Point, OR 97458 jobsearchRemoteWorkSummary
Regular Full Time
Pay Range: 77350.00-104650.00



The Healthcare Services Concept Support Specialist provides support to assigned Segment Specialists by maintaining current audit concepts as well as provide support for the development process of new audit concepts performing the following essential duties:


  • Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly).  Collaborates with and leverages Segment Specialist expertise to ensure on-point results.
  • Ensure training material updates (may develop or coordinate) as necessary for changes to existing concepts. -May contribute to development of training materials and tools for new concepts.
  • Conduct research, identify impact on existing concepts, and document accordingly (may support Segment specialists with research for new concepts).
  • Interpret and apply policy in existing concept review/updates or ask may be requested in support of Segment Specialists for new concepts.
  • Support activities required to package concepts, including, but not limited to, pulling together necessary documents, and supporting data in appropriate order and locations, coordinating activities and documenting process steps, proofing documents, and tracking/reporting status.
  • Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial)
  • Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance with high degree of accuracy and quality providing status reports and deliver results on-time.
  • May serve as back-up to Segment Specialists for certain activities, if needed, in their absence.
  • May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims, as necessary.
  • May provide support for calls with providers/client representatives as necessary.
  • May contribute to evaluation of existing audit guidelines and ideas to improve finding rate, reduce dispute/appeal rate, and decrease overturn rate.
  • Stay abreast of industry policy.
  • May participate in and support statistical analysis to drive scoring and selection for new audit concepts.
  • May support the responses to provider/client representative from written inquiries as it pertains to audited claims, as necessary.
  • Works very closely with other team members to ensure on time project deliveries, cross train, and knowledge transfer, and maintain required quality and productivity standards.
  • Performs other duties as assigned and required to meet business needs.

*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:
  • 2-4 years of Outpatient audit experience.
  • CPC, COC, RHIA, or RHIT certification.
  • Demonstrated knowledge of applicable Medicare and Commercial policy and claims process, and ability to research and analyze the same, to successfully perform the job.
  • Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding.
  • Knowledge of the national coding standards, particularly payment rules.
  • Knowledge of Medicare and commercial claims processing systems.
  • Ability to understand and apply complex policies, procedures, regulations, and legal statutes.
  • Excellent organization, coordination, and administrative skills.
  • Strong verbal communication and interpersonal skills; ability to communicate with all levels within the organization and with diverse teams.
  • Excellent written communication skills; including proofing and editing.
  • Good critical thinking, questioning, and listening skills; excellent attention to detail.
  • Strong critical thinking and analytical skills.
  • Flexibility to handle non-standard situations as they arise; and adaptable to changing business needs in a fast-paced dynamic environment.
  • Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames.
  • Strong proficiency in Microsoft Word, Excel, SharePoint (advanced skills highly desirable), and easily learns and adapts to new applications and systems.

 -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 may be in a busy standard is performed in an office environment with moderate noise level or 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:

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, 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.

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: 2023-08-29 Expires: 2023-12-03
Analytics, audit, and recovery services for healthcare, government and student loans.



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Healthcare Services Concept Support Specialist (Outpatient SME) - Remote

Performant Financial
Myrtle Point, OR 97458


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