1+ months

Medical Appeals Specialist (SCA) - temporarily remote in San Angelo, TX area

San Angelo, TX 76903 Work Remotely
Regular Full Time

***NOTE COVID-19***: 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.

The Medical Appeals Specialist (SCA) 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.

Duties Include:

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, MACs 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

*Note - 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:

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.

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.

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.

Employment VISA Sponsorship is not available for this position and authorization to work in the United States is required prior to employment. 

Job Profile is subject to change at any time.

EEO - 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: 2021-01-22 Expires: 2021-03-25
Analytics, audit, and recovery services for healthcare, government and student loans.

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Medical Appeals Specialist (SCA) - temporarily remote in San Angelo, TX area

Performant Financial
San Angelo, TX 76903

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