Performant Sr. Healthcare Billing Recovery MSP Operations Analyst - NGHP in Remote - Sunrise, Florida
Sr. Healthcare Billing Recovery MSP Operations Analyst - NGHP
Location:Remote - Sunrise, FL
Status:Regular Full Time
The Senior Healthcare Billing Recovery MSP Operations Analyst – NGHP leverages solid operational insurance, Medicare Secondary Payer (“MSP”) and Coordination of Benefits (“COB”) knowledge, coupled with a broad system skills, expert NGHP insurance billing and claims knowledge, reporting and analysis, and other “subject matter” skills needed to support the MSP Commercial Repayment Center (“CRC”) contract and its NGHP operations. This position interfaces with the MSP department operations, third-parties (clients, payers and other CMS MSP contractors), and internal information systems groups to support the correct intake and processing of NGHP correspondence, and the correct adjudication of decisions on NGHP disputes, demands and related correspondence that have been disputed and/or appealed by the related NGHP or their authorized representative. Job duties include, but are not limited to:•Understands MSP NGHP workflows and processes and serves as an advisor to NGHP operations and other MSP CRC departments interacting with the NGHP operations. •Creates, analyzes and disseminates various trend analysis reports based upon CMS systems and Performant data systems that assist the NGHP operational team in understanding the effectiveness of its operations. •Proactively identifies potential issues, gaps, continuous improvement opportunities, or areas of concern or need. Researches and gathers information from diverse sources and distills into succinct business cases to the manager.•Identify concerns and issues from NGHPs and bring them to the NGHP management team’s attention.•Assist with sharing CRC related processing information with NGHPs as directed by management and CMS. •Assist in answering NGHP questions regarding MSP policy and guidelines such as what is acceptable to satisfy the fee schedule requirement, required wording for timely filing defenses, requirements for eligibility and coverage letters, etc. •Assist in the maintenance of a NGHP stakeholder and community contact list. •Act as an internal Subject Matter Expert for how NGHPs may work more effectively with the MSP CRC. •Assist NGHPs in understanding where their Section 111 reporting may be affecting the demands received from the MSP CRC. •Supports operational initiatives and leverages knowledge toward development and delivery of tools and training that disseminate information and educate applicable operations management and staff, and workflow documentation, process maps and standard operating procedures.•Develops collaborative relationships internally and externally•Accountable for task ownership, meeting deadlines and operating maturity with minimal supervision and direction in the form of project assignments •May lead or support various projects and activities in support of the MSP contract operations. •Upon hire (and process facilitated by the Company through the client) obtain and maintain required government client clearances.•Performs any other duties as may be assigned.*Notes: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:
•Expert knowledge of Non Group Health Plans, Section 111 Reporting and how these two topics interface/interact with and impact the MSP CRC contract. •Solid understanding of the administrative appeal rights. Specifically, Redeterminations, Reopenings, and Dismissals process as defined in Title 42: Public Health Chapter IV Subchapter B Section 405.904-405.986 •Strong operational knowledge of Non Group Health Plans Medicare Secondary Payer operations•Solid knowledge of insurance billing, claims and applicable terminology and how these processes relate to Medicare claims from a secondary payer perspective•Strong Microsoft Office suite skills; intermediate Excel•Outstanding written and verbal communication skills•Good critical thinking, questioning, and listing skills•Demonstrated ability to effectively build relationship and work collaboratively across business units and functions, both internally and externally. •Ability to develop and maintain trust and credibility•Ability to synthesize information from several different sources required to troubleshoot issues or lead assigned initiatives •Analytical and critical thinker with strong research skills that thrives on solving complex problems•Good judgement and excellent attention to detail•Ability to work independently with work instruction in the form of objectives with minimal oversight•Ability to deliver day-to-day support to the business with a professional attitude and exceptional organization skills under pressure•Ability to adapt to rapidly changing business requirements and applying skills in effective and innovative way to meet dynamic business needs.•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.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 a 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:
•Bachelor's degree or equivalent combination of education and experience•10+ years of experience working directly with Non Group Health Medicare Secondary Payer operations and the determination of Coordination of Benefits. •Demonstrated experience in insurance operations as it relates to Medicare Secondary Payer operations and the Coordination of Benefits with the Medicare program.•2+ years of experience in a function demonstrating the ability to work collaboratively with internal and external partners, stakeholders, and clients. •Demonstrated experience analyzing complex issues and helping others to understand where processes may need to change in order to make operations more effective. •Experience interfacing and influencing effectively in a positive manner with internal and external contacts•Experience using independent judgment to solve sometimes complex customer and stakeholder issues, concerns and/or complaints.
Other Requirements•Must submit to and pass pre-hire background check, as well as additional checks throughout employment.•Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.•Must submit to and pass drug screen pre-employment (and throughout employment).•Performant is a government contractor. Certain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the Company. Visa sponsorship is not available.Job Profile is subject to change at any time.EEO Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation 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. NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZED AGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER