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Healthcare Billing Recovery QA Specialist
Job Code:2019-50-6-020
Location:Sunrise, FL
Status:Regular Full Time
As a Healthcare Billing and Recovery Quality Assurance Specialist you will be assigned to the CMS Medicare Secondary Payer recovery program with responsibilities to include, but not limited to:

•Ability to share knowledge and educate employees, including case specialists and other QA Specialists, on healthcare related to Quality Standards, terminology, procedures, and related information. 
•Responsible for analyzing large sets of data and reporting relative trends to management, and handling complex questions or quality related issues.
•Initiate applicable action and documentation based upon quality audit reviews with respective team leads and managers within the organization.
•Responsible for ensuring system updates are completed by caseworkers following quality audits that result in a necessary correction.
•Leverage your maintained case work knowledge and expertise in medical billing/COB/TPL/MSP to review documentation and claim billing, Measure and quantify claim accuracy levels within each audited claim.   May provide training to other QA team members. 
•Responsible for maintaining impartiality and strict confidentiality on quality audit results.
•Follows through to ensure auditing and reporting activities is on-time and accurate in accordance with policies and procedures.
•Effectively communicate quality audit results to employees, and effectively escalate disagreement with audit findings through the appropriate procedures.
•Arrives to work on-time, works assigned schedule, and maintains regular attendance. 
•Follows and complies with company and departmental 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 achieve or exceed established metrics and goals assigned.
•Demonstrates Performant core values in performance of job duties and all interactions.
•Ability to work independently to select random sampling to carry out assigned audits
•Work overtime as may be required. 
•May be required to work some Performant holidays due to client requirement.
•May be assigned casework to meet organizational needs and stay current on case knowledge. 
•Performs other duties as assigned. 
Required Skills and Knowledge:

• Proven ability to gather and interpret large sets of claim data and apply Quality standard operating measures to data.
• Prefer strong past work history and experience in supporting and guiding employees concurrent with Standard Operating Procedures.
• Protect patients data privacy, understands and adheres to HIPAA standards and regulations. 
• Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service approach while communicating Quality data and SOP’s to case worker employees.
• Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
• Must have intermediate proficiency using Excel Spreadsheets; sorting, organize large sets of data, access data efficiently, adjusting and creating formulas. 
• Proven ability to adapt and provide support and guidance to others on changing work process, and process improvements efficiently and effectively.
• Ability to follow process, procedures and regulations in the workplace.
• Prior experience working defined operational standard and understanding that contractual obligation.
• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
• Must have demonstrated excellent time management skills.
• Prior Experience working defined operational standard and understanding the contractual obligations.  
• Possess the proven ability to personality type that is ethical, friendly, hard-working and proactive.

Education and Experience:

•Minimum 12 months of experience in medical billing experience demonstrating depth of knowledge and capability required for the position. 
•Minimum 3 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills preferably in a healthcare or related industry.
•High School diploma or GED
•Requires demonstrated work history in a quality assurance auditing capacity
•Experience with Coordination of Benefits and Medicare Secondary Payer involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties. 
•Previous experience with Medicare, healthcare billing procedures, medical terminology. 
Prior experience in a role identifying and tracking quality trends in the healthcare industry.

Physical Requirements:
Job is in a busy standard office environment with moderate noise level, sits at a desk during scheduled shift, 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 performing work; reach as needed to use office equipment.
• Consistently viewing a computer screen and types frequently, but not constantly, using a keyboard to update accounts.
• 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.