Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

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Healthcare Third Party Liability Regulatory Specialist - US Remote
Job Code:2020-50-6A-055
Location:Remote - Sunrise, FL
Status:Regular Full Time
  
Responsibilities:

The TPL Regulatory Specialist provides consultative supports for Performant’s Healthcare team by providing research, insights, and recommendations with laws and regulations related to Performant’s Eligibility and Claiming Integrity Services. In addition to internal consultation, the TPL Regulatory Specialist is responsible for outreach into the healthcare community to establish and maintain relationships with stakeholders relevant to accomplishing Performant’s coordination of benefits and payment integrity business objectives.

Essential Duties:

•Identify, research, understand state and Federal laws and regulations that impact Performant’s eligibility and claiming integrity products and services

•Collaborate with and provide recommended actions to senior management in addressing potential legal and/or regulatory roadblocks to business objectives

•Identify, prioritize, and lead outreach efforts for healthcare community stakeholders to facilitate eligibility data sharing and claims processing.
o This function may involve management of subordinate outreach personnel.

•Initiate, negotiate, and maintain appropriate contracting vehicles for eligibility data sharing, claims processing, and other situations needed to accomplish Performant’s business objectives.

•Maintain positive, collaborative relationships with healthcare community stakeholders and serve as a single point of contact for troubleshooting, escalation, and resolution for those relationships

 

•Remain informed of legal changes, guidelines, and judgments from healthcare industry that could impact Performant’s Healthcare

•Support Healthcare Operations with ad hoc scenarios where regulations, state laws, or Federal laws intersect, including general escalation assistance for operational issues and/or disputes

•Collaborate with Performant’s General Council, Compliance, and senior business leadership in drafting and refining contracts, policies, procedures, and other business collateral

•Propose healthcare operational or relational enhancements to the organization from a legal or regulatory perspective, included but not limited to the Third-Party Liability (TPL) and Reclamation teams, Medicare Secondary Payer (MSP), and Coordination of Benefits (COB).

•Other duties as assigned

*Note - 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.

Required Skills and Knowledge:

•Working knowledge of healthcare financials and how legal, compliance, and regulatory requirements and guidelines affect recovery and eligibility management
•Proficient in MS Word and Excel
•Intermediate skills in litigation, transcript databases
•Strong written and verbal communication skills
•Exceptional research skills, analytical ability and keen attention to detail
•Highly skilled in documentation and text analysis applicable for the role
•Ability to manage multiple, and sometimes conflicting, priorities and meet deadlines
•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.


Physical Requirements:

•Performs duties in a busy standard office environment with moderate noise level or may work remotely from home-office as may be required based upon business needs, in accordance with company policies & procedures.
•Sits or stands at a desk during scheduled shift, reaching as needed to use office equipment.
•Makes and returns calls using an 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).
•Types frequently, but not constantly, using a keyboard and mouse.
•Occasionally lifts/carries/pushes/pulls up to 10 pounds.
•Travel as required to meet business needs.
Education and Experience:
•Degree in business, management, healthcare administration, regulatory science, or related, or equivalent combination of education and experience. Juris Doctorate degree preferred
•5+ years of legal research and contracting experience
•3+ years in healthcare experience (direct experience with eligibility, claiming, and/or revenue cycle preferred)
Demonstrated experience working with healthcare stakeholders and regulatory entities
•Demonstrated experience with project management, relationship management, and documentation
 


Other Requirements:

•Must submit to and pass pre-hire background check, as well as additional checks throughout employment
•Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
•Must submit to and pass drug screen pre-employment (and throughout employment).
•Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company.
  
Visa sponsorship is not available.

Job Profile is subject to change at any time.

EEO

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. 

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZED AGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER