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

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Healthcare Billing and Recovery Quality Assurance Specialist Lead (Sunrise, FL or San Antonio, TX)
Job Code:2021-50-6A-078
Location:United States - Remote (multiple locations)
Status:Regular Full Time
  
Responsibilities:
**Available for hire in locations that are within a commutable distance to: Sunrise, FL., & San Antonio, TX Offices

As a Healthcare Billing and Recovery Quality Assurance Specialist Lead you will be assigned to the CMS Medicare Secondary Payer recovery program performing QA Specialist review functions as well as serving as a point of escalation and support for the QA Specialists on the team as well as support for the QA Supervisor and Management with department level reporting, activities, and initiatives. Responsibilities that include, but not limited to:

QA Specialist Duties
•Ability to share knowledge and educate employees, including Case Specialists and QA Specialists, on healthcare related to Quality Standards, terminology, procedures, and related information. 
•Responsible for analyzing large sets of data and reporting relative trends to management and handling complex questions or quality related issues.
•Initiate applicable action and documentation based upon quality audit reviews with respective team leads and managers within the organization.
•Responsible for ensuring system updates are completed by caseworkers following quality audits that result in a necessary correction.
•Leverage your maintained case work knowledge and expertise in medical billing/COB/TPL/MSP to review documentation and claim billing, Measure and quantify claim accuracy levels within each audited claim.   May provide training to other QA team members. 
•Responsible for maintaining impartiality and strict confidentiality on quality audit results.
•Follows through to ensure auditing and reporting activities is on-time and accurate in accordance with policies and procedures.
•Effectively communicate quality audit results to employees, and effectively escalate disagreement with audit findings through the appropriate procedures.
•Arrives to work on-time, works assigned schedule, and maintains regular attendance. 
•Follows and complies with company and departmental 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.
•Demonstrates Performant core values in performance of job duties and all interactions.
•Ability to work independently to select random sampling to carry out assigned audits
•Work overtime as may be required. 
•May be required to work some Performant holidays due to client requirement.
•May be assigned casework to meet organizational needs and stay current on case knowledge. 

Lead Duties
•Serve as a positive role model and lead by example and demonstrates knowledge and expertise in carrying out scope of responsibilities through achieving excellent performance results, as well as compliance, attendance and behavior
•Provides support to team members by providing answers to questions, as well as handles escalation from team members and complex cases 
•Proactively supports research, analysis and resolution of questions and issues that arise or as assigned by management
•Assist management in developing tools and/or communicating changes in requirements, systems, processes and procedures, as well as supports transition and adaptation by the team in a positive and effective manner
•Review team and individual productivity and established metrics and identify potential issues and recommendations to applicable in-line supervisory or management staff
•Participates in plan/provider outreach activity, inventory assignment for specific case activities, and serve as point of coordination for one or more areas of operational functions in support of the broader department. 
•Support client audits and other projects as assigned by management

Other Duties
•Performs other duties as assigned.

*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 
Required Skills and Knowledge:
**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.

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Below are representative of the knowledge, skills, and abilities required:
• Demonstrated strong competency in performing case work relevant to CRC CMS MSP scope and consistently deliver high results and quality. 
• Prior experience working defined operational standard and understanding that contractual obligation.
• Proven ability to gather and interpret large sets of claim data and apply Quality standard operating measures to data.
• Strong past work history and experience in supporting and guiding employees concurrent with Standard Operating Procedures. (Note: Performant CRC QA Experience preferred) 
• Protect patients data privacy, understands and adheres to HIPAA standards and regulations. 
• Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service approach while communicating Quality data and SOP’s to caseworker employees.
• Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
• Must have intermediate proficiency using Excel Spreadsheets; sorting, organize large sets of data, access data efficiently, adjusting and creating formulas. 
• Proven ability to adapt and provide support and guidance to others on changing work process, and process improvements efficiently and effectively.
• Ability to follow process, procedures and regulations in the workplace and demonstrated ability to serve as a positive role model for other operations staff
•Ability to effectively share information and train others for better results
•Ability to respond to inquiries and provide constructive feedback effectively
•Strong verbal and written communication skills; including excellent phone and email etiquette
•Strong problem-solving skills
•Ability to maintain professionalism and composure in difficult interactions or conflict
•Ability to successfully perform function with minimum supervision
•Applies good judgment and decision making 
•Ability to consistently perform job responsibilities.
•Possess a personality type that is ethical, friendly, hard-working and proactive.
•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.
• Must have demonstrated excellent time management skills.
• Prior Experience working defined operational standard and understanding the contractual obligations.  
• Possess the proven ability to personality type that is ethical, friendly, hard-working and proactive.
•Completion of Teleworker Agreement upon hire, and adherence to the Agreement (including applicable policies and procedures), which includes, but not limited to, basic home office suitability requirements such as high-speed internet connectivity, appropriate work-space for compliance with confidentiality, HIPAA, safety and ergonomics, and work environment allowing dedicated work-focus without distraction during work hours.


Physical Requirements
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; head-set is also provided
•Occasionally lift/carry/push/pull up to 10lbs.
Education and Experience:
•High School diploma or GED
•Minimum 4+ years of medical billing experience, including Medicare (healthcare billing procedures, medical terminology, Coordination of Benefits and Medicare Secondary Payer involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties, etc. ), demonstrating depth of knowledge and capability required for the position 
•Requires demonstrated work history in a quality assurance auditing capacity, performing QA reviews as well as identifying and tracking quality trends in the healthcare industry.
•Some experience in leadership capacity for functional area or serve as subject matter expert, trainer or other scope with responsibility for supporting and contributing to the success of others on the team. 
 

Other Requirements
Note that as a Government Contractor, Performant has certain regulatory and client requirements, such as background and/or clearances, Federal Drug Free Workplace, and other compliance requirements and policies.
•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) and comply with Drug Free Workplace Policies.
•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.