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

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Healthcare Coordination of Benefits (COB) Data Mining Analyst, Sr.
Job Code:2021-50-R-033
Location:United States - Remote
Status:Regular Full Time
  
Responsibilities:

The Sr. Healthcare Coordination of Benefits (COB) Data Mining Analyst is responsible for objectively and accurately completing conducting audit review and analysis on assigned client inventory, while maintaining high quality work output and successfully meeting productivity and recovery goals.  This position makes identifies trends and makes determinations based subject matter expertise and strong analytical while leveraging audit tools and resources available.  Communicates and supports the identification of additional data mining opportunities and participates in development of ideas as necessary. Able to contribute to resolution of more complex issues or client requirements, and may supporting training and guidance to other Audit Recovery Analysts and Data Mining Analysts.

• Conducts COB investigations and associated claims reviews and determines if claims are appropriately paid in accordance with COB rules, commercial billing guidelines and contracts, CMS regulations, and applicable laws and policies.

• Documents findings within audit tracking system and maintains thorough and objective documentation of findings.

• Investigates, researches, and analyzes claims data, applying knowledge of medical or pharmacy policy to determine proper order of benefits with other payers, both Medicare and commercial.

• Creates narrative rationale to correspond with audit determinations.

• Meets and achieves assigned revenue goals and assigned metrics.

• As needed, supports findings during the appeals process.

• Serves as a senior claims payment resource; provides claims and reimbursement expertise, and guidance to the team.

• Works collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse.

• Monitors, tracks and reports on all work conducted.

• Consults with our clients, data analysts, other claims payment resources and contractors as necessary.

• Maintains current in depth knowledge of changes in technology, practice and regulatory issues that may affect our clients.

• Proactively contributes to process improvement activities and sets positive example for group participation and takes ownership in improvement initiatives.

• Actively contributes in quality assurance functions, development of member investigation guidelines and training.

• Proactively identifies and recommends opportunities for cost savings and improving outcomes.

• Serves as positive role model and example for other Analysts.

• May support training and guidance to other Analysts.

• Complies with company policies, processes and procedures.

• Successfully completes, retains, applies and adheres to content in required training as assigned that includes but not limited to information security, anti-harassment and other compliance and policy/procedures training applicable for position.

• Demonstrates Performant core values in performance of job duties and all interactions.

• Performs other duties as assigned


*Notes:
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.

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.

Required Skills and Knowledge:

 

• Coordination of benefits, medical claims processing, and reimbursement subject matter expertise.

• Depth of knowledge of commercial insurance programs (including billing guidelines and contracts), CMS, regulations and applicable laws and policies. 

• Demonstrated ability to apply breadth and depth of applicable business and industry knowledge to developing approaches to customer data mining opportunities as well as continuous improvement initiatives.

• Strong analytical skills.

• Ability to be flexible and seizes the opportunity to cross train.

• Ability to maintain high quality work while meeting deadlines, revenue goals, and performance metrics.

• Excellent organizational, interpersonal and communication skills

• Demonstrated ability to resolve complex problems .

• Ability to serve as a positive role model to more junior staff members.

• Demonstrated ability to train and support team members with less experience with positive interaction and results.

• 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.

• Acute sense of professionalism and confidentiality.

• Typing skills and working knowledge of computer functions and applications such as MS office (Outlook, Word, Excel).

• Intermediate to advanced level of proficiency with Microsoft Excel, Word and Access.

• Capability of working in a fast-pace environment, flexibility with assignments and the ability to adapt in a changing environment.



• 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 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.

• Job is performed in an 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:

• Bachelor’s degree or an equivalent level of competence obtained through experience, education and/or training.

• 8+ years of experience in the health care industry in eligibility or claims analyst type of function.

• 5+ years of experience with clearing houses/claims processing systems (e.g. UNET, COSMOS, NDB, TOPS, FACETS, AMYSIS, MHS, etc.)

• 5+ years working with large volumes of membership or eligibility data.

• Experience with CMS shared data files and CAQH files preferred.




Other Requirements:

• 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