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

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HCS Customer Service Specialist II
Job Code:2020-50-2-007
Location:Lathrop, CA
Status:Regular Full Time
  
Responsibilities:

***NOTE COVID-19***: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.

Customer Service Specialists focused on Performant’s commercial healthcare client contracts are the primary points of contact for all providers, payers, etc. They respond to all inquiries and provide supporting documentation. In addition, they conduct improper claims payment recovery efforts. 


***NOTE COVID-19*** Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.

Essential duties:

•Facilitate and process requests from and/or to the Performant Team
•Make necessary contacts and/or perform necessary research to validate provider contact information
•Contact healthcare providers on overpaid claims and maintain collection records and account status updates
•Develop professional working relationships with colleagues, healthcare providers, payers, and other applicable third-parties
•Establish good contact with providers to guarantee proper claim presentation and follow up
•Enter and update all contact and activity information into the applicable Performant system where not automatically completed by the system, e.g., a telephone call is made, recorded, and attached to the case file in the system, but the outcome must be extracted from the call and input into system
•Notify management of:  
    -all correspondence indicating displeasure with the Payer, in the overpayment identification, or in the recovery methods utilized; 
    -legal action; 
    -government intervention;
    -escalated concerns regarding audit issues and edit parameters; 
    -suggestions to improve or correct processes or documents

•Research and route internal/external communications to the appropriate person or department, including referrals and documents, calls, and faxes
•Conduct critical due diligence follow-ups of unread media
•Answers questions from providers and resolves issues via phone and written correspondence
•Educating providers on their appeal rights
•Communicate with other staff/departments as necessary 
•Maintain a current knowledge of all applicable rules, regulations, policies and procedures related to assigned client programs
•Maintain current knowledge of all applicable contract requirements and objectives based upon assignment
•Maintain HIPAA Certification
•Conduct simple coding reviews
•Perform miscellaneous duties as assigned in a highly professional manner
Required Skills and Knowledge:
•Thorough working knowledge of CPT/HCPCs/ICD-9 coding
•Excellent verbal and written communication skills
•Skilled in data entry and knowledge of computers
•Courteous, professional, and respectful attitude
•Strong understanding of customer service policies and processes
•Provider customer service background
•Basic understanding of accounts payable and receivable
•Possess knowledge of applicable rules and regulations
•Claims processing and/or billing experience
•Proficient in the use of HCFA/UB forms
•Flexibility to handle any non-standard situations that may arise
•Must be able to multi-task
•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:

**NOTE: Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements) until at which time staff will be notified and required to work from a Performant office location. Basic office equipment required to perform remote work is provided by the company.
-Job is in a busy standard is performed in an office environment with moderate noise level (or may be home-office setting subject to Company approval and Teleworker Agreement), sits at a desk during scheduled shift, uses office phone or headset provided by the Company for calls, making outbound calls and answering inbound return 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).
-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 and types frequently, but not constantly, using a keyboard to update accounts.
-Consistently communicates on the phone as required primarily within the department and company and may include client contacts or other third-party depending on assignment with account holders, may dial manually when need or use dialer system; headset is also provided.
-Occasionally lift/carry/push/pull up to 10lbs.
 
Education and Experience:

•4+ years Medical claims processing, and/or medical customer service
•2+ years claims billing
•Hospital billing experience preferred
•High School diploma or equivalent


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