Performant Healthcare, Inc. · 1 month ago
Healthcare Services Concept Development Specialist (Post Acute SME)
United States
Full-time
Remote
Entry, Mid Level
$78K/yr - $104K/yr
2+ years expPerformant Healthcare, Inc. is part of Machinify, a leading healthcare intelligence company focused on improving healthcare payment processes. The Healthcare Services Concept Development Specialist will support Segment Specialists by maintaining and developing audit concepts, ensuring compliance with industry policies, and collaborating on training materials.
AnalyticsCustomer ServiceFinancial Services
Responsibilities
Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly). Collaborates with and leverages Segment Specialist expertise to ensure on-point results
Ensure training material updates (may develop or coordinate) as necessary for changes to existing concepts. May contribute to development of training materials and tools for new concepts
Conduct research, identify impact on existing concepts, and document accordingly (may support Segment specialists with research for new concepts)
Interpret and apply policy in existing concept review/updates or ask may be requested in support of Segment Specialists for new concepts
Support activities required to “package” concepts, including, but not limited to, pulling together necessary documents, and supporting data in appropriate order and locations, coordinating activities and documenting process steps, proofing documents, and tracking/reporting status
Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial)
Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance with high degree of accuracy and quality providing status reports and deliver results on-time
May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims, as necessary
Stay abreast of industry policy
Works very closely with other team members to ensure on time project deliveries, cross train, and knowledge transfer, and maintain required quality and productivity standards
Performs other duties as assigned and required to meet business needs
Qualification
Required
At least 2-4 years of audit or Payment Integrity experience
RN and/or CPC, COC, RHIA, or RHIT certification
Demonstrated knowledge of applicable Medicare and Commercial policy and claims process, and ability to research and analyze the same, to successfully perform the job
Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding
Knowledge of the national coding standards, particularly payment rules
Knowledge of Medicare and commercial claims processing systems
Ability to understand and apply complex policies, procedures, regulations, and legal statutes
Strong verbal communication and interpersonal skills; ability to communicate with all levels within the organization and with diverse teams
Excellent written communication skills; including proofing and editing
Good critical thinking, analytical, questioning, and listening skills; excellent attention to detail
Flexibility to handle non-standard situations as they arise; and adaptable to changing business needs in a fast-paced dynamic environment
Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames
Strong proficiency in Microsoft Word, Excel, SharePoint (advanced skills highly desirable), and easily learns and adapts to new applications and systems
Preferred
Registered Nurses (RNs) are strongly preferred; Certified Coders will also be considered
Benefits
Medical
Dental
Vision
HSA/FSA options
Life insurance coverage
401(k) savings plans
Family/parental leave
Paid holidays
Paid time off annually
Company
Performant Healthcare, Inc.
Billions of dollars are lost each year to waste, improper payments and unpaid debts.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$25MKey Investors
Wells Fargo
2023-11-07Post Ipo Debt· $25M
2012-08-10IPO
Leadership Team
Simeon Kohl
Chief Executive Officer
Rohit R.
Chief Financial Officer
Recent News
2024-11-12
2024-11-06
Company data provided by crunchbase