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

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Healthcare Coordination of Benefits (COB) Data Mining Analyst
Job Code:2023-53-R-020
Location:United States - Remote
Status:Regular Full Time
Pay Range:46800.00-55,000
  
Responsibilities:
The Coordination of Benefits (COB) – Data Mining Analyst is responsible for objectively and accurately complete claim audit reviews on assigned audits while meeting quality and productivity performance goals.  This position makes determinations based on claims payment expertise and knowledge while using audit tools and resources available.  Communicates and supports the identification of additional data mining opportunities and participates in development of ideas, as necessary. 

-Conducts COB investigations and associated claims reviews and determines if claims are appropriately paid in accordance with COB rules, 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 as needed, supports findings during the appeals process. 
-Serves as a senior claim payment resource; provides claims payment expertise and claims payment 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 to 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 Audit Recovery Analysts. 
-Attends conference calls and meetings as requested. 
-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.

*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.

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:
• Ability to maintain high quality work while meeting deadlines and performance metrics 
• Excellent organizational, interpersonal and communication skills 
• Strong analytical skills with demonstrated ability to resolve complex problems and strives for continuous improvement. 
• Protect patients’ privacy, understands and adheres to HIPAA standards and regulations.
• Solid working knowledge of medical claims processing, Coordination of Benefits (COB), and claims processing as it relates to COB.
• Knowledge of insurance programs, particularly the coverage and payment rules
• Ability to be flexible and seizes the opportunity to cross train
• Demonstrated knowledge and skills working with claims processing systems.
• 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.
• Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc. 
• Intermediate level of proficiency with Microsoft Excel, Word and Access.
• Capability of working in a fast-paced 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.

•  Applicants must have reliable, secure, high speed Internet access at their home office location.


 
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:
Education and Experience:

•Bachelor’s degree or an equivalent level of competence obtained through combination of experience, education and/or training. 
•3 years of relevant experience (preferably in the healthcare industry) demonstrating knowledge and skills to be successful in the position.
•Experience with claims processing systems such as UNET, COSMOS, NDB, TOPS, FACETS, AMYSIS, MHS, etc. 
•Demonstrated experience working with large volumes of healthcare membership or eligibility data, including 1 year in directly relevant eligibility or claims analyst role.
•Experience working with CMS shared data files and CAQH files preferred.