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

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Healthcare Eligibility (COB) Representative
Job Code:2020-50-9-002
Location:Nashville, TN Area
Status:Regular Full Time
  
Responsibilities:
We are seeking highly-skilled, talented eligibility analysts with strong knowledge of healthcare eligibility, medical terminology, eligibility validation practices, Coordination of Benefits and Third Party Liability (COB/TPL), an Medicare Secondary Payer (MSP); proven ability to gather information, answer questions, and resolve primacy issues through coordination of benefits when multiple forms are of coverage are available; and communicate effectively with carriers to update validated eligibility records and primacy. 

As a Healthcare Eligibility (COB) Representative, you will review assigned records, investigate coverage, and determine primacy to maximize revenue for our client’s recovery programs with responsibilities to include, but not limited to:

Essential Duties:
•Review eligibility and other documentation to verify current payer order of benefits.
•Leverage your knowledge and expertise in COB/TPL/MSP to review documentation and eligibility, investigate the file to determine proper order of benefits and answer questions and/or provide information that will bring to successful payment or other appropriate account action.
•Contact Healthcare Insurance carriers, employers, and/or providers regarding eligibility discrepancies
•Educate Healthcare Insurance carriers, employers, and/or providers on the Coordination of Benefits Rules
•Analyze and understand written communication from insurance companies including explanation of benefits (EOBs)
•Support internal groups or functions with gathering and interpretation of the eligibility work to development with knowledge base and understanding of key concepts and terminology in healthcare eligibility.
•Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance carriers, employers, and/or providers
•Efficiently and diligently work through assigned inventories to meet productivity metrics assigned by management.
•Leverage your knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g. eligibility research and claims appeals)
•Initiate applicable action and documentation based upon insurance carriers selected 
•Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable
•Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
•Follows and complies with company, departmental and client program 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, including but not limited to, production and quality.
•Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.)
•Demonstrates Performant core values in performance of job duties and all interactions.
•Correct areas of deficiency and oversight received from quality reviews and/or management.
•Work overtime as may be required.
•Performs other duties as assigned.
 
Required Skills and Knowledge:
•Knowledge and experience with Healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovery and/or researching the same.
•Experience with Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer
•Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve primacy issues.
•Ability to communicate professionally and effectively with providers, carriers, beneficiaries and other audiences regarding eligibility and/or Coordination of Benefits (COB). 
•Proven ability to gather and interpret Explanation of Benefits (EOB) and answer questions and resolve issues with payment
•Protected patients’ privacy, understands and adheres to HIPAA standards and regulations.
•Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude.
•Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
•Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
•Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.).
•Ability to follow process, procedures, and regulations in the workplace.
•Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment.
•Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
•Ability to consistently perform job responsibilities.
•Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
•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:
•Minimum 6 months of relevant experience, including Healthcare, demonstrating depth of knowledge and capability required for the position.
•Minimum 2 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills.
•High School diploma or GED
 


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