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

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Health Care Business Intelligence Data Analyst
Job Code:2021-50-6A-058
Location:United States - Remote
Status:Regular Full Time
  
Responsibilities:

The Healthcare Data Business Intelligence Analyst's focus is to create and maintain new audit concepts and algorithms for Performant’s Client contract through concept research, data analysis, preparation of rule documents and code lists, and updating existing edits as needed. This position also creates complex and data mining pre-payment edits and algorithms.

 

Essential Responsibilities:

  • Identifying and developing new concepts to recoup inappropriate Medicare payment.
  • Identifying concepts for potential recoupment through automated and complex audits by analyzing health services utilization data (e.g., Medicare claims) and researching sources of new concepts
  • Researching concepts approved for development
  • Applying appropriate Medicare, Medicaid  and other regulatory policy and rules
  • Participating in development of new concepts
  • Creating new concept proposal forms
  • Writing good cause and rationale documents
  • Identifying pertinent regulatory back-up and references
  • Developing selection criteria/edit parameters, including refining probes, analyzing probe results
  • Selecting claim examples to prove the concept
  • Assisting in the creation of medical review guidelines, as needed
  • Mentoring and coordinating subcontractor
  • Work with Data Mining Auditors and Data Engineering teams to develop and refine probes
  • Performing QA functions of new concepts
  • Working in partnership with department co-workers and across departments
  • Keeping abreast of medical practice, changes in technology, and regulatory concepts that may affect the Client contract
  • Lead the ideation efforts within Performant teams

*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:

  • Expertise in ICD-9-CM, ICD-10-CM/PCS, CPT-4, and HCPCS coding;
  • Knowledge of the national coding standards, particularly payment rules
  • Knowledge of commercial claims processing systems
  • Knowledge of the Medicare program, particularly medical policy and payment
  • Experience analyzing and manipulating health care data.
  • Experience with diagnostic grouper tools and techniques (DRG, ETG, MEG) a plus. 
  • Data manipulation skills using database and spreadsheet applications.
  • Working knowledge of database applications, including extraction and querying skills.
  • Ability to analyze raw data and disseminate results, with ability to think logically, and process    sequentially with a high level of detailed accuracy and coach junior analysts to perform same.
  • Excellent written and verbal communication skills, with the ability to multitask and prioritize projects for self and subordinate team members, to meet scheduled deadlines.
Additional Requirments:

•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 may be notified and required to work from a Performant office location on an ad-hoc or periodic basis.

Basic office equipment required to perform remote work is provided by the company.
•Job is performed in a standard busy 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:
  • 10 plus years of healthcare provider reimbursement experience specific to managed care contracting, medical billing, claims auditing, claims analysis and/or actuarial analysis.
  • BA/BS degree in Nursing,  CS, Finance or Accounting preferred


Other Requirements:

Performant is a Government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and clearances (as applicable).
•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.
  
Employment VISA Sponsorship is not available for this position

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