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Healthcare Third Party Liability (TPL) Operations Analyst
Job Code:2019-50-2-007
Location:Lathrop, CA
Status:Regular Full Time
  
Responsibilities:
The Healthcare Third-Party Liability (TPL) Operations Analyst leverages solid operational knowledge coupled with a broad system skills, functional healthcare billing/claims knowledge, reporting and analysis, and other skills to support the department.  This position interfaces with the department operations, third-parties (clients, payors, providers), and internal information systems groups to support set-up of electronic data interfaces (EDI); provide reporting insights to monitor claim, payment and denials management activity; support allocation of work/claim focus to the team; troubleshooting workflow and data issues; and supporting client and payer questions regarding groups of claims.
Job duties include, but are not limited to:

Understands departmental dataflow needs and serves as an intermediary between department operations, third-parties (client communication, payer outreach), and internal groups (such as IT, Insight/DPE resources, and contracts/legal) to:
o Gather and submit information required for the set-up electronic data interfaces (EDI);
o Serve as liaison to support Identification of root causes and resolve issues involving data exchange issues;
o Ensure NDAs and other required documents are completed in the set-up of new EDI feeds
Creates, analyzes and disseminates various reports using Insight (IDS) to monitor claim activity, payment flow, and other operational activity; taking specific actions based upon information. 
Proactively identifies potential issues, gaps, continuous improvement opportunities, or areas of concern or need.  Researches and gathers information from diverse sources and distills into succinct business cases to the manager.
May serve directly or in support of management as liaison and respond to internal and external inquiries regarding data updates (EDI) and claims related activity 
Supports operational initiatives and leverages knowledge toward development and delivery of: tools and training that disseminate information and educate applicable operations management and staff, and; workflow documentation, process maps and standard operating procedures.
Develops collaborative relationships internally and externally
Accountable for task ownership, meeting deadlines and operating maturity with minimal supervision and direction in the form of project assignments 
Performs any other duties as may be assigned to support the Healthcare TPL department
 
Required Skills and Knowledge:
Solid internal operations knowledge as well as applied technology understanding from a user and workflow perspective
Understands business processes and demonstrated ability to effectively leverage applicable systems (Insight-IDS/DPE, Recovery system, EDIs, etc.) to perform job function. 
Strong Microsoft Office suite skills; intermediate Excel
Demonstrated ability to work with large data-sets to report on and analyze key operational metrics and activities.
Solid knowledge of healthcare billing, claims and applicable terminology
Good working knowledge of TPL, Reclamation, payor billing and denials management.
Outstanding written and verbal communication skills
Good critical thinking, questioning, and listing skills
Effectively builds relationship and collaborates effectively across business units and functions, including, but not limited to TPL department, healthcare division resources, IT, clients, and payer entities.
Ability to develop and maintain trust and credibility
Ability to synthesize information from several different sources required to troubleshoot issues or lead assigned initiatives  
Analytical and critical thinker with strong research skills that thrives on solving complex problems
Good judgement and excellent attention to detail
Familiarity with internal applications and technical concepts of how they interface and how to leverage to support business operations most effectively
Ability to work independently with work instruction in the form of objectives with minimal oversight
Ability to deliver day-to-day support to the business with a professional attitude and exceptional organization skills under pressure
Ability to adapt to rapidly changing business requirements and applying skills in effective and innovative way to meet dynamic business needs
Education and Experience:
Experience
Bachelor's degree or equivalent combination of education and experience
4+ years of experience in healthcare billing/recovery demonstrating depth and breadth of experience in healthcare billing/claims and recovery business operations knowledge to successfully perform job functions.
2+ years of experience in a function demonstrating the ability to lead or make strong contributions to initiatives involving operations workflow, data reporting and analysis, and contributing to the set-up of new clients or programs.
Demonstrated experience regathering and documenting data and requirements for projects and/or complex problem solving.
Experience interfacing and influencing effectively in a positive manner with internal and external contacts
Experience working with large data sets delivering meaningful reporting and analysis.
Experience using independent judgment to solve sometimes complex customer, claims, workflow, systems/dataflow, and other operations issues. 
 
Physical Requirements: 
Job is in a busy standard office environment with moderate noise level, sits at a desk and participates in meetings, uses 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; has the option to stand as needed while on calls; reach as needed to use office equipment. 
- Consistently viewing a computer screen, typing, using a keyboard and mouse. 
- Uses phone; head-set can be provided. 
- Occasionally lift/carry/push/pull up to 10lbs. 


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 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 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.


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