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SalaryABOUT 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: Tooffer 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: $46,800 - $52,000The Coordination of Benefits (COB) Data Mining Analyst is responsible for objectively and accurately completing 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.
Key Responsibilities to include:
- 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 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.
- 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.
- Attends conference calls and meetings as requested.
- Complies with company policies, processes, and procedures.
- Performs other duties as assigned.
Knowledge, Skills and Abilities Needed:
- Ability to maintain high quality work while meeting deadlines and performance metrics
- Excellent organizational, interpersonal and communication skills
- Demonstrated ability to resolve complex problems and strives for continuous improvement.
- Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.
- Experience with Medicaid, Coordination of Benefits
- Ability to communicate professionally and effectively with providers, carriers, beneficiaries and other audiences regarding eligibility and/or Coordination of Benefits (COB).
- Proven ability to research coverage on online payer portals.
- 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.
- 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.
Preferred Knowledge, Skills and Abilities:
- Working knowledge of Coordination of Benefits and medical claims processing.
- Knowledge of insurance programs, particularly the coverage and payment rules
- Ability to be flexible and seizes the opportunity to cross train
Required and Preferred Qualifications
- Bachelor’s degree or an equivalent level of competence obtained through experience, education and/or training.
- 3+ years of experience in the health care industry, preferably in an eligibility or claims analyst role
- 3+ years of experience with claims processing systems such as UNET, COSMOS, NDB, TOPS, FACETS, AMYSIS, MHS, etc.
- 1+ years of working with membership or eligibility data. Experience working with CMS shared data files and CAQH files are preferred but not required.
WHAT WE OFFER:
Performant offers a wide range of Benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.
Physical Requirements & Additional Notices:
If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee’s responsibility to maintain this Internet access at their home office location.
The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.
- Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone 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 computer mouse.
- Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).
- Regularly sit/stand 8 or more hours per day.
- Occasionally lift/carry/push/pull up to 10lbs.
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 other clearances (as applicable). As such, the following requirements will or may apply to this position:
- Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
- Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.
- Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.
- Other requirements may apply.
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.
Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant’s Human Resources team to discuss further.
Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant 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.
