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

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Healthcare Services Segment Specialist - DME (Commercial)
Job Code:2021-50-7R-003
Location:United States - Remote
Status:Regular Full Time
  
Responsibilities:

The Healthcare Services Segment Specialist - DME (commercial) applies specific subject matter expertise in the Durable Medical Equipment (DME) to support of audit business activity performing the following essential duties:

-Support the responses to provider/client representative from written inquiries as it pertains to audited DME claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of  Performant to review audited DME claims, as necessary
-Support strategic DME market development by attending sales meetings and other industry specific events.
-Provide leadership of DME audit strategy as per each unique contract.
-Review audit concepts & help determine alignment/adjustment according to line of business and client policy
-Evaluate existing audit guidelines and make recommendations to improve finding rate, reduce dispute/appeal rate and decrease overturn rate
-Develop or rewrite review guidelines, as necessary
-Develop and conduct and/or support training of analytic, audit and clinical staff as necessary
-Identify, interpret and apply policy in concept development or program consultation. Stay abreast of industry policy
-Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial)
-Participate in and support statistical analysis to drive scoring and selection for new audit concepts
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Support the responses to provider/client representative from written inquiries as it pertains to audited claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of  Performant to review audited claims, as necessary
-Works very closely with other team members to ensure on time project deliveries. 


Other Duties

*Performs other duties as assigned and required to meet business needs.


*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.
 


*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.

*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:
  • Demonstrated expertise (depth and breadth) of knowledge of DME claims
  • Strong interpersonal skills; ability to communicate with all levels within the organization and with diverse teams
  • Excellent written and verbal communication skills
  • Good critical thinking, questioning, and listening skills; excellent attention to detail.
  • Strong critical thinking and analytical skills.
  • Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames.
  • Desired Technical Knowledge and Experience
  • 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
•Job 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 documents.
•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, may dial manually when need or use dialer system; headset is also provided.
•Occasionally lift/carry/push/pull up to 10lbs.
 
Education and Experience:
  • Bachelor's degree in related field or equivalent experience
  • Minimum 8+ years of progressive experience in healthcare claim type subject matter specialty specific to the position
  • Progressive health care data analysis experience including gathering and documenting requirements for projects of all sizes


Other Requirements:
•Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
•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