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Healthcare Billing Recovery Conditional Payment Notice Specialist - INTERNAL APPLICANTS ONLY
Job Code:2020-50-6-002
Location:Sunrise, FL
Status:Regular Full Time
  
Responsibilities:
The Healthcare Billing and Recovery CPN Specialist contributes to the operations team’s achievement of Statement of Work (SOW) requirements for the Center for Medicare and Medicaid Systems (CMS) Medicare Secondary Payer (MSP) client contract with a focus on Conditional Payment Notices (CPNs).  Leverages healthcare billing and Medicare claim expertise, medical coding knowledge, claim review, and CMS MSP  program to optimize the selection and initiation of CPNs aligned with operational objectives. Duties include, but not limited to:

•Understands and evaluates data factors that contribute to Non Group Health claim records that have the greatest opportunity for recovery for the MSP program and revenue generation for Performant, while also having the smallest impact on the volume of appropriate/applicable incoming correspondence.
•Audits and analyzes details of potential CPNs by comparing specific Common Procedural Terminology (CPT) codes, Diagnosis Codes, Diagnosis Related Group (DRG) codes, etc., related to each potential CPN associated with the identified incident or injury type. 
•Based upon review of the Non Group Health data in the system identifies the correct and appropriate individual pre-demand CPNs  to be selected for processing that meet the applicable criteria.  
•Completes selection of appropriate CPNs for generation mailing to applicable NGHPs and/or their respective Recovery Agents.   
•Tracks and reports CPNs generated on a daily, weekly and monthly basis.  Reporting may minimally include, but not be limited to, the total number of CPNs generated each day, the financial value for said CPNs and the entities for which the CPNs were generated for.  Produces reports as requested by management.
•Runs reports and analyzes information to project potential and track actual correspondence generated to the CRC as a result of the selected CPNs.  Runs reports and tracks additional information as may be needed to for trending and analysis on the activity related to selected CPNs including but not limited to the associated revenue generated, processing time and related expenses, and Return on Investment (ROI).   
•Responsible for meeting monthly forecasted CPN volume processing. 
•Maintains current and full functionality knowledge and capability on applicable systems and Standard Operating Procedures (SOPs) for selecting and processing CPNs in order to successfully review and select CPNs in accordance with operational objectives and compliance of the program, and position purpose.  
•Performs Non-Group Health Plan (NGHP) case work meeting all required production and quality standards applicable to the CRC contract/program as defined by applicable Performant Policies during periods of decline in CPN review activity and/or as directed by management to support business needs.   
•Responsible for reporting trends, submitting system enhancement requests, and other suggestions to enhance CPN selection process.
•Other duties as assigned.
 
Required Skills and Knowledge:
•Demonstrated knowledge and expertise in the audit and analysis of Medicare billing and claims information. 
•Medical Coding knowledge gained through certification, and/or experience in the analysis and comparison of Medicare claims data to NGHP claims information in order to determine if the Medicare program appropriately paid as the primary insurer. 
•Excellent knowledge of healthcare billing, and demonstrated understanding of the relationship between health insurer based claims and non-group health claims in order to understand Payer primacy responsibilities.
•Demonstrated ability to audit and analyze large volumes of data related to medical claims and billing, with distinct ability to identify coding variances and comparisons to treatment plans and incidents on non-group healthcare plans (NGHP)
•Proficiency in using databases, Excel spreadsheets, and related billing data administrative platforms to accurately transfer and submit claims data, as well as prepare reports and perform data analysis .  
•Previous exposure or experience in using BCRS, HIGLAS and claims processing/adjudication systems, etc., related to the Centers for Medicare Services (CMS) and Non-Group Health Plans (NGHP). 
•Strong computer skills using Excel, Word, Power point, Outlook, and other Microsoft suite programs. 
•Ability to effectively perform and deliver individual results, while also working cooperatively with others to promote positive team environment. 
•Ability to work full-time on-site during assigned schedule and as needed to meet business needs. 
•Demonstrated ability to maintain positive attitude and good judgment in fast passed dynamic environment. 
•Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
•Ability to follow process, procedures and regulations in the workplace.
•Protected patients’ privacy, understands and adheres to HIPAA standards and regulations.
•Mind-set of continuous improvement and adapts quickly to change.
 
Education and Experience:
•High school diploma or GED
•Medical Coding Certification (preferred), or previous experience in Medical Coding analysis using up-to-date ICD-9 and/or ICD-10 Coding, and strong knowledge of service level coding systems such as CPT, HCPCS, DRGs, etc.
•6+ years of experience in medical billing , with strong history specific to processing and auditing Medicare claims, demonstrating depth of knowledge and capability required for the position. 
•Experience as user and administrative functionality of Benefits Coordination & Recovery System (BCRS) and the Healthcare Integrated General Ledger Accounting System (HIGLAS) strongly preferred.   

Physical Requirements
•Performs duties in a busy standard office environment with moderate noise level.
•Sits at a desk during scheduled shift (8 or more hours per day); standing, walking and reaching as needed to use office equipment.
•Consistently viewing a computer screen and types frequently, but not constantly, using mouse and keyboard to enter data and move data within computer systems.
•Reads and comprehends information in electronic (computer) or paper form (written/printed). 
•Consistently communicates via email, skype, and other forms of electronic communication tools, as well as phone as needed. 
•Occasionally lift/carry/push/pull up to 10 lbs. 


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.