12 hours

Healthcare Services Segment Specialist - OutPatient

Performant Financial
Sunrise, FL
  • Job Code
    2019-50-6A-043
Performant Financial Corporation
Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

Healthcare Services Segment Specialist - OutPatient
Job Code:2019-50-6A-043
Location:Remote - Sunrise, FL
Status:Regular Full Time
  
Responsibilities:
The Healthcare Services Segment Specialist applies specific subject matter expertise in Outpatient (OP) Coding to support of audit business activity performing the following essential duties:

-Support the responses to provider/client representative from written inquiries as it pertains to audited Outpatient claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of Performant to review audited Outpatient claims, as necessary
-Support strategic OP Coding auditing market development by attending sales meetings and other industry specific events.
-Provide leadership of OP Coding auditing strategy as per each unique contract.
-Be able to QA and probe OP Coding audit concept request after submitting to analytics team and determine if the language of the concept was converted correctly to pull correct claims for review.
-Explain to audit team what outpatient coding concept was created and how to review claims that are pulled from that concept. 
-Review audit concepts & help determine alignment/adjustment according to line of business and client policy
-Evaluate existing audit guidelines and make recommendations to improve finding rate, reduce dispute/appeal rate and decrease overturn rate
-Develop or rewrite review guidelines, as necessary
-Develop and conduct and/or support training of analytic, audit and clinical staff as necessary
-Identify, interpret and apply policy in concept development or program consultation. Stay abreast of industry policy
-Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial)
-Participate in and support statistical analysis to drive scoring and selection for new audit concepts
-Support the responses to provider/client representative from written inquiries as it pertains to audited claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of  Performant to review audited claims, as necessary
-Works very closely with other team members to ensure on time project deliveries. 
-Performs other duties as assigned and required to meet business needs
Required Skills and Knowledge:
Demonstrated expertise (depth and breadth) of knowledge of Outpatient claims – such as ICD-10, CPT and HCPCS codes.
Strong interpersonal skills; ability to communicate with all levels within the organization and with diverse teams
Excellent written and verbal communication skills
Good critical thinking, questioning, and listening skills; excellent attention to detail.
Strong critical thinking and analytical skills.
Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames.
Strong Microsoft suite skills, such as – Excel, Word, Outlook and SharePoint. 
 
Education and Experience:

Bachelor's degree in related field or equivalent experience
Must have OP coding experience
RN license a plus
Outpatient Coding Certificate a plus

Minimum 8+ years of progressive experience in healthcare claim type subject matter specialty specific to the position – must have created concepts for healthcare audits in relation to outpatient claims. A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology. 
Progressive health care data analysis experience including gathering and documenting requirements for projects of all sizes
 

Other Requirements

-Must submit to and pass background check. Must not have any Federal or State liens resulting from County, State or Federal tax issues.  Must not have any current defaulted student loans.
-Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors.
-Must submit to and pass drug screen.


Job Profile is subject to change at any time.


Performant Financial Corporation is a government contractor and 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.
 
 
  

Categories

Posted: 2019-12-04 Expires: 2020-01-03

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Healthcare Services Segment Specialist - OutPatient

Performant Financial
Sunrise, FL

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