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

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Healthcare Provider Contract and Pricing Analyst
Job Code:2021-50-6A-058
Location:United States - Remote
Status:Regular Full Time
  
Responsibilities:

The focus of the Healthcare Provider Contract and Pricing Analyst is to create and maintain fee schedules for Performant claims repricing, and contract audit departments.  This includes quality assurance of fee schedule loads and creation of queries to identify improper payments.


Duties:

•Interpret provider contract payment information for use by the complex and automated teams
•Develop logic for queries to identify inappropriate payments
•Analyze data results to ensure accuracy of contract interpretation and system loads
•Create and process system files, and needed workflows using available tools, specific layouts, conditions, and instructions to create overpayment files
•Respond to internal and external questions regarding data results and pricing calculations
•Support concept development by researching concepts and applying appropriate Medicare, Medicaid and other regulatory policy and rules
•Select claim examples to prove and quantify the concept value
•Keeps abreast of medical practice, changes in technology, and regulatory concepts, or changes in reimbursement that may affect the Client contracts
•Participate in the development or analysis of new concepts and related data
•Other duties as assigned 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.
Required Skills and Knowledge:

•Expertise in ICD-10-CM/PCS, CPT-4, and HCPCS coding; 
•Experience with diagnostic grouper tools such as DRG, APR-DRG, EAPG, APC preferred 
•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 
•Ability to work independently and meet deadlines
•Data manipulation skills using database and spreadsheet applications 
•Working knowledge of database applications such as SQL and/or VBA, including extraction and querying skills 
•Expertise using Microsoft Excel and the ability to quickly develop expertise in new systems and applications. 
•Ability to analyze raw data and disseminate results.  Use of logical and critical thinking skills and exceptional problem-solving skills to identify solutions to complex scenarios
•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 other team members, to meet scheduled deadlines.

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:

**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).

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:
 
•BA/BS degree in relevant field, or equivalent combination of relevant education and experience.
•5+ years of healthcare provider reimbursement experience specific to managed care contracting, medical billing, claims auditing, claims analysis and/or actuarial analysis relevant to the position.

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