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

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HCS Customer Service Specialist II
Job Code:2019-50-2-003
Location:Lathrop, CA
Status:Regular Full Time
  
Responsibilities:
Customer Service Specialists are the primary points of contact for all providers, Medicare contractors, etc. They respond to all inquiries and provide supporting documentation. In addition, they conduct improper claims payment recovery efforts.

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 and other Medicare contractors
• Establish good contact with providers to guarantee proper claim presentation and follow up
• Enter and update all contact and activity information into MARS where not automatically completed by the system, e.g., a telephone call is made, recorded, and attached to the case file in MARS, but the outcome must be extracted from the call and input into MARS
• Notify management of:  
    • all correspondence indicating displeasure with the RAC, 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 received from Medicare contractors and documents, calls, and faxes sent to Medicare contractors by mistake
• 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 Medicare rules, regulations, policies and procedures
• Maintain current knowledge of all contract requirements and objectives
• 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 CMS 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
• Sit/stand/ walk 8-10 hours/day
• Lift/carry/push/pull under and over 10lbs occasionally
• Keying frequency, handling, reaching, fine manipulation
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 background check. 
-Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors.
-Must submit to and pass drug screen.

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.



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.