Healthcare Services Concept Specialist - Payment Integrity Expert for Medicare, Medicaid, and Commercial Healthcare

Join Performant, a Leader in Healthcare Payment Integrity

At Performant, we're revolutionizing the healthcare industry by providing technology-enabled services that identify improper payments and prevent losses due to errant billing practices. As the premier independent healthcare payment integrity company in the US, we're committed to helping our clients achieve their goals and focus on what matters most - quality of care and healthier lives for all. We're now seeking a highly skilled Healthcare Services Concept Specialist to join our team on a remote basis.

About the Opportunity

We're offering a competitive salary range of $78,000 - $104,000 for this critical role, which is essential to our mission. As a Healthcare Services Concept Specialist, you'll provide vital support to our Segment Specialists by maintaining current audit concepts and contributing to the development of new ones. This is a unique chance to leverage your expertise and experience in healthcare payment integrity to drive success and grow professionally.

Key Responsibilities

• Review and update existing audit concepts based on periodic review cycles or as needed due to client or regulatory changes, collaborating with Segment Specialists to ensure accurate results.
• Develop and coordinate training material updates for changes to existing concepts and contribute to the creation of training materials and tools for new concepts.
• Conduct research, identify the impact on existing concepts, and document findings accordingly, supporting Segment Specialists with research for new concepts as needed.
• Interpret and apply policy in existing concept reviews and updates, and provide support for new concepts as required.
• Support activities required to "package" concepts, including coordinating documents, data, and process steps, proofing documents, and tracking/reporting status.
• Ensure audit concepts are well-formulated for various Offerings (Data Mining, Complex Audit, FWA Leads, CMS, Medicaid, and Commercial).
• Manage multiple tasks within multiple workflows for audit concept maintenance with high accuracy and quality, providing status reports and delivering results on-time.
• Contribute to responses to provider/client representatives regarding audited Medicare claims as necessary.
• Stay up-to-date with industry policy and work closely with team members to ensure timely project deliveries, cross-train, and knowledge transfer, maintaining required quality and productivity standards.
• Perform other duties as assigned to meet business needs.

Essential Qualifications and Skills

To succeed in this role, you'll need:

• Demonstrated knowledge of applicable Medicare and Commercial policy and claims processes, with the ability to research and analyze the same.
• Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding.
• Understanding of national coding standards, particularly payment rules.
• Familiarity with Medicare and commercial claims processing systems.
• Ability to understand and apply complex policies, procedures, regulations, and legal statutes.
• Strong verbal and written communication skills, with the ability to communicate with diverse teams and levels within the organization.
• Excellent critical thinking, analytical, and problem-solving skills, with attention to detail.
• Flexibility to handle non-standard situations and adapt to changing business needs in a fast-paced environment.
• Time management skills to manage multiple tasks simultaneously and complete work within allocated time frames.
• Proficiency in Microsoft Word, Excel, SharePoint, and the ability to learn new applications and systems.

Preferred Qualifications

• 2-4 years of audit or Payment Integrity experience.
• CPC, COC, RHIA, or RHIT certification and/or RN.

What We Offer

At Performant, we prioritize our employees' well-being and offer a comprehensive benefits package, including:

• Medical, dental, vision, and disability coverage options.
• Life insurance coverage.
• 401(k) savings plans.
• Paid family/parental leave.
• 11 paid holidays per year.
• Sick time and vacation time off annually.

We're committed to creating a diverse and inclusive environment, and we're 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.

Work Environment and Requirements

This is a remote role, and you'll need:

• Reliable, secure high-speed Internet at your home office location.
• A dedicated workspace that meets our physical demands and requirements, including sitting at a desk, using a computer, and phone.

As a government contractor, we're subject to compliance with client contractual and regulatory requirements, including background checks, drug testing, and other clearances. You'll need to:

• Submit to and pass a pre-hire criminal background check and drug test.
• Obtain and maintain client-required clearances.
• Adhere to our Teleworker Agreement and related policies and procedures.

Join Our Team

If you're a motivated and experienced Healthcare Services Concept Specialist looking for a new challenge, we encourage you to apply. As a key member of our team, you'll have the opportunity to drive success, grow professionally, and contribute to our mission. Apply now and take the first step towards a rewarding new role!

Seize this opportunity to make a significant impact. Apply now and join our team of experts in healthcare payment integrity.