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: $41,600 - $52,000
The Healthcare Eligibility Analyst II plays an important role in the success of the Eligibility services we provide our clients by applying strong knowledge and skills to review and analyze large volumes of client records, investigate coverage to determine primacy, and initiate coverage updates that maximize revenue for our clients. The Analyst demonstrates strength of knowledge and skills by adapting quickly to add value to various client programs, consistently exceed productivity and quality results, as well as identify and resolve non-standard eligibility updates and primacy issues that drive revenue. The level II Analyst may contribute to continuous improvement projects or new client programs, as needed.
Key Responsibilities
• Leverage knowledge and expertise in COB/TPL/MSP to gather and review documentation and eligibility information, investigate the file to determine proper order of benefits when multiple forms of coverage are available, and resolve primacy issues.
• Demonstrate ability to routinely identify and solve non-standard and often complex data or record discrepancies and/or issues and successfully navigate to achieve results consistently with scope of assignment including multiple carriers, TPL, and other characteristics. Demonstrates ability to apply skills and meet expectations across multiple client programs.
• Communicate effectively with carriers to update validated eligibility records and primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Contact Healthcare Insurance carriers, employers, and/or providers regarding eligibility discrepancies.
• Educate Healthcare Insurance carriers, employers, and/or providers on the Coordination of Benefits Rules, and demonstrates ability to respond to complex questions.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Effectively works assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group.
• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) demonstrating ability to consistently resolve the most complex eligibility discrepancies and questions.
• Initiate applicable action and documentation based upon insurance carriers selected.
• Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable.
• May contribute to ideas and approaches to further the enhancement of our products and services, workflows, documentation, and training.
• May partner with Sr. Analysts or management to contribute to various projects, continuous improvement efforts, training materials, or development for new client programs.
• Serves as a positive example and upon request, able to assist representatives and junior analyst team members to answer questions and assist in knowledge/skill enhancement.
• May contribute to quality review activity upon management request.
• 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, quality, and completion of assigned projects with high quality and timely results.
• Correct areas of deficiency and oversight received from quality reviews and/or management.
• Performs other duties as assigned.
Knowledge, Skills, And Abilities Needed
• Strong knowledge and material on-point experience with healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovering and/
Location: Anywhere
Posted: Oct. 21, 2024, 9:21 p.m.
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