Healthcare Billing Recovery Outreach Specialist I
hace 7 meses
ABOUT PERFORMANT:
At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission:
_ To_
- offer innovative payment accuracy solutions that allow our clients to focus on what matter most - quality of care and healthier lives for all_.
If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture - then Performant is the place for you
ABOUT THE OPPORTUNITY:
Hiring Range: $19.50/hr
As a Healthcare Billing Recovery Outreach Specialist I, you are assigned health insurance carrier, auto/home/worker’s comp insurance carrier, or legal representatives (“stakeholders”) of Group Healthcare (GHP) and/or Non-Group Healthcare Provider (NGHP) cases under the CMS Medicare Secondary Recovery Program. The Outreach team works with the Medicare Secondary Payer (“MSP”) Debtor stakeholder community for Performant’s assigned cases to address their high priority questions and concerns regarding MSP case demands and related MSP correspondence. In addition, the Outreach team provides education and feedback to this MSP stakeholder community to help them understand the full scope of Performant’s responsibilities and operating processes, as well as the stakeholder’s corresponding responsibilities to ensure that MSP debts are paid timely and accurately.
Key Responsibilities- Leverage your knowledge and expertise in TPL/COB/MSP to review case documentation and any previous case work and activities completed by caseworkers to validate liability, responses to defenses regarding payment liability, status the account and letter correspondence, etc. in preparation to respond to and/or reach out to stakeholders.- Answer questions (on the phone and/or in writing as appropriate) and/or provide information and education to the stakeholder(s) that will bring to successful payment or other appropriate account action.-
- Initiate correct action with applicable party and documentation based upon payment option, actions required if review of case and/or new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.- Updates client and/or company systems with clear and accurate information such as involved party(ies) contacting the CRC, notes from contact dialog, as well as account status updates as applicable.- Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.- Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.- Arrives to work on-time, works assigned schedule, and maintains regular good attendance.- Follows and complies with company, departmental and client program 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, including but not limited to, production and quality.- Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and, successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.)- Demonstrates Performant core values in performance of job duties and all interactions.- Correct areas of deficiency and oversight received from quality reviews and/or management.- Work overtime as may be required.- May be required to work some Performant holidays due to client requirement.- Performs other duties as assigned.
Knowledge, Skills and Abilities Needed- Knowledge and experience with medical claim billing procedures, medical terminology and medical coding (including information in forms UB04 and CMS 1500), preferably in a role generating, auditing, recovery and/or researching the same including Medicare and Medicaid claims.- Experience with Coordination of Benefits (COB), Third Party Liability (TPL), Medicare Secondary Payer (MSP) with proven expertise in gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues, including Medicare and Medicaid claims.- Demonstrated ability to successfully complete high-quality MSP GHP and NGHP
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