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

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Medical Appeals Specialist (SCA)
Job Code:2022-50-4-005
Location:San Angelo, TX
Status:Regular Full Time
  
Responsibilities:
Available for hire Teleworking in the following area/location: San Angelo, Texas (Tom Green, County).


The Medical Appeals Specialist (SCA) performs reconciliation of appeals received from the Provider/MAC, as well as serving as a critical point of contact between the MAC and other internal departments within Performant. As the Medical Appeals Specialist, you will join a team of experienced medical auditors. You will work in a fast paced and dynamic environment and be part of a multi-location team. The successful candidate will be a team player able to collaborate with a variety of different entities to solve problems and generate solutions.

 • Applying appropriate Medicare policy and rules

 • Documenting all findings referencing the appropriate policies and rules

 • Generating letters articulating outcomes as needed

 • Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse

 • Work in partnership with CMS, CMD colleagues, MAC’s and other Medicare contractors on improving Medicare policies, provider education, and system edits

 • Collaborate policies and procedures pertinent to the RAC review process

 • Keep abreast of medical practice, changes in technology, and regulatory issues that may affect the RAC contract

 • Work with the project team to minimize appeals

 • Suggest ideas that may improve work flow

 • Attend MAC meetings as scheduled

 • Assist with training review team members

 • Interface with and support the Medical Director

 • Cross train in all departments/areas as requested

*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:

 • Knowledge of the Medicare program, particularly the coverage and payment rules.
 
 • Knowledge of appeals processes

 • Knowledge of claims processing

 • Strong knowledge of medical documentation.

 • Possess knowledge of CMS rules and regulations.

 • Ability to maintain high quality work while meeting strict deadlines.

 • Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.
 
 • Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members.
 
 • Flexibility to handle any non-standard situations that may arise.
 
 • Courteous, professional, and respectful attitude.

 • Excellent written and verbal communication skills.

 • Must be able to multi task.

 • Knowledge of appeals processes
 
Additional Requirements:


 • 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:

Available for hire teleworking in the following area/location:  San Angelo, Texas (Tom Green, County). 

**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:

 • Experience with ICD-9, CPT-4 or HCPCS coding.

 • 1+ years experience in health care claims that demonstrates expertise in Medicare claims data such as for medical billing experience for an Insurance Company or hospital required.

 • Not currently sanctioned or excluded from the Medicare program by the OIG.

 • Claim processing experience



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.


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