Senior Healthcare Reclamation Analyst

ABOUT PERFORMANT:

At Performant, we're focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most - quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture - then Performant is the place for you!

ABOUT THE OPPORTUNITY:

The Sr. Healthcare Reclamation Analyst reviews and analyzes large volumes of client data and payer correspondence, investigates coverage to determine eligibility and primacy, and gathers and interprets explanation of benefits and payer feedback in order to recover funds for clients who have paid in error. Additionally, the senior role leverages subject matter expertise and experience to perform a variety of activities and projects such as supporting team development, handling client requests, analysis, and reporting, as well as initiatives developing and continuous improvement of operational infrastructure and initiating new client programs.

Key Responsibilities

• Leverage knowledge and expertise in COB/TPL/Recovery to gather and review in-house data with payer correspondence to determine proper order of benefits and resolve primacy issues.
• Successfully solve complex data or record discrepancies and/or issues.
• Communicate effectively with carriers to determine primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Contact Healthcare Insurance carriers regarding claim responses.
• Educate Healthcare Insurance carriers on the Coordination of Benefits rules and appropriately responds to complex questions.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Actively collaborate with internal groups and/or functions with gathering and interpretation of the claims billing process and denial management for continuous improvement in workflow and systems.
• Actively contributes to continuous improvement and development for new client programs of scripts, guidelines, and other tools provided to have professional conversations with Healthcare Insurance carriers and/or providers.
• Effectively works assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group.
• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) and consistently resolve the most complex eligibility discrepancies and questions.
• Initiate applicable action and documentation based upon insurance carriers selected.
• Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable.
• Supports management with inventory assessment and distribution to team members.
• Provide ongoing feedback to Management and Analytics Teams to further the enhancement of our products and services, workflows, and documentation.
• Assist Management on assigned projects (including ramping up new client programs), client requests, regular reporting, data analysis and reconciliations, testing, and analytics reviews as required by the business.
• Serve as a mentor/subject matter expert to representative and junior analyst team members to maximize their potential throughout their development process and leads by example.
• Conducts quality reviews on work performed by team representatives and analysts on the team as requested by management.
• Supports team training activities and contributes to development and enhancement of training materials and tools.
• Leads and contributes to ad-hoc projects and initiatives and establishing best practices.
• Consistently maintains regular good attendance, demonstrates professionalism, sound judgment, and good decision making.
• 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 achieves or exceeds established metrics and goals assigned, including but not limited to, production, quality, and completion of assigned projects with high quality and timely results.
• Completes required processes to obtain client required clearances as well as company required 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.
• Corrects areas of deficiency and oversight received from quality reviews and/or management.
• Performs other duties as assigned.

Knowledge, Skills and Abilities Needed

• Strong knowledge and substantial experience with Healthcare, medical terminology, and high-level medical coding, preferably in a role generating, auditing, recovering and/or researching the same.
• Demonstrated expertise and experience with Coordination of Benefits, Third Party Liability and Accounts Receivable specifically relevant to the line of business.
• Proven strength gathering and interpreting Explanation of Benefits (EOB) to answer questions and resolve complex primacy issues.
• Demonstrates high degree of critical thinking and analytical accuracy required to be successful in the role.
• Ability to communicate professionally and effectively with carriers, carriers and other audiences regarding claims and Coordination of Benefits (COB).
• Strong investigative skills, with proven ability to gather and interpret Explanation of Benefits (EOB) and answer questions and resolve standard as well as complex issues with payments.
• Protect 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; develops positive rapport with clients.
• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
• Strong skills using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
• Intermediate to advanced Microsoft Excel skills with demonstrated skills analyzing large data sets relevant to the position.
• Applies knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.) and can provide instructional support to others.
• Ability to follow policy, procedures, and regulations in the workplace, and demonstrates ability to lead by example and support development of junior team members.
• Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment; effectively serve as subject matter expert, lead by example, and a lead contributor to the team overall results and progress.
• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes; able to support team adaptation to change.
• Ability to consistently perform job responsibilities.
• Ability to obtain and maintain client required clearances as well as pass company required background and/or drug screening.
• 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.

Required and Preferred Qualifications

• High School diploma or GED; college preferred: equivalent combination of education and related experience.
• Minimum 4 years of directly related progressive experience (billing reclamation, recovery, eligibility, etc.), including Coordination of Benefits, Third Party Liability, and/or Reclamation, demonstrating depth and breadth of knowledge and capability required for the position.
• Minimum 1 year of experience in a function demonstrating the ability to lead or make strong contributions to initiatives involving operations workflow, data reporting and analysis, contributing to the set-up of new clients or programs, or subject matter expertise applied to department workflows or projects, direct or indirect staff oversight or training, etc.
• Demonstrated experience gathering, researching, interpreting, and documenting data and requirements for projects and/or complex problem solving.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone 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 computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

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

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

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 Performant's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant's Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant 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.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED