7 hours

Medical Appeals Specialist (SCA)

Performant Financial
San Angelo, TX
  • Job Code
    2020-50-4-001
Performant Financial Corporation
Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

Medical Appeals Specialist (SCA)
Job Code:2020-50-4-001
Location:San Angelo, TX
Status:Regular Full Time
  
Responsibilities:
The Medical Appeals Specialist performs reconciliation of appeals received from the Provider/MAC, as well as serving as a critical point of contact between the MAC and other internal departments within Performant. As the Medical Appeals Specialist, you will join a team of experienced medical auditors. You will work in a fast paced and dynamic environment and be part of a multi-location team. The successful candidate will be a team player able to collaborate with a variety of different entities to solve problems and generate solutions.

• Applying appropriate Medicare policy and rules
• Documenting all findings referencing the appropriate policies and rules
• Generating letters articulating outcomes as needed
• Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
• Work in partnership with CMS, CMD colleagues, MAC’s and other Medicare contractors on improving Medicare policies, provider education, and system edits
• Collaborate policies and procedures pertinent to the RAC review process
• Keep abreast of medical practice, changes in technology, and regulatory issues that may affect the RAC contract
• Work with the project team to minimize appeals
• Suggest ideas that may improve work flow
• Attend MAC meetings as scheduled
• Assist with training review team members
• Interface with and support the Medical Director
• Cross train in all departments/areas as requested
Required Skills and Knowledge:

Physical Requirements

Job is in a busy standard office environment with moderate noise level, sits at a desk during scheduled shift, 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; reach as needed to use office equipment

•Consistently viewing a computer screen and types frequently, using a keyboard 

•Frequently communicates on the phone or in person

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

Education and Experience:


• Experience with ICD-9, CPT-4 or HCPCS coding.
• Knowledge of the Medicare program, particularly the coverage and payment rules.
• Ability to maintain high quality work while meeting strict deadlines.
• Excellent written and verbal communication skills.
• Not currently sanctioned or excluded from the Medicare program by the OIG.
• Knowledge of appeals processes
• Knowledge of claims processing
• Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.
• Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members.
• Strong knowledge of medical documentation.
• Courteous, professional, and respectful attitude.
• Possess knowledge of CMS rules and regulations.
• Flexibility to handle any non-standard situations that may arise.
• Must be able to multi task.
• One or more years experience in health care claims that demonstrates expertise in Medicare claims data such as for medical billing experience for an Insurance Company or hospital required.
• Knowledge of appeals processes
• Claim processing experience



Other Requirements

Must submit to and pass background check. 
Must be able to pass a criminal background checks; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment lists.
Must submit to and pass drug screen. Performant is a Drug-Free Workplace.
Performant is a government contractor. Certain client assignments for this position may require additional background and/or clearances.


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.
 
No agency submissions.
  

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Posted: 2020-02-24 Expires: 2020-03-25

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Medical Appeals Specialist (SCA)

Performant Financial
San Angelo, TX

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