3 days old
2017-12-072018-01-06

Healthcare Billing Recovery Case Specialist II

Performant Financial
Miami Lakes, FL
  • Job Code
    2017-50-7-014
Performant Financial Corporation

Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

Healthcare Billing Recovery Case Specialist II
Job Code:2017-50-7-014
Location:Miami Lakes, FL
Status:Regular Full Time
  
Responsibilities:
A Career Opportunity for the motivated high performer looking for more than just a job!  

Performant is a market leader that delivers analytics, audit and recovery services for healthcare, government and student loans.  We’re more than brick and mortar – we are about helping people. It’s a dynamic, fast-paced and fun workplace like a start-up, but with the backing of a profitable public company with a history of growth.

We are looking for highly-skilled, talented medical billing specialists with strong knowledge of medical claim billing, medical terminology and medical coding, forms UB04 and CMS 1500, Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims, and procedural challenges regulations; experience generating or auditing medical claims and billing; proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; and communicate effectively with carriers to recapture payments. 

As a Healthcare Billing Recovery Case Specialist II (Case Worker) you will be assigned Non-Group Healthcare Provider delinquent accounts under the CMS Medicare Secondary Payer recovery program with responsibilities to include, but not limited to:

• Review account claim and other documentation to verify payment liability for claims paid by Medicare in error. 
• Make outbound calls to contact Non-Group Health Plan Insurance carriers (such as Worker’s Compensation, Auto carriers, and liability insurances) regarding payment of claims; answer questions and educate liable third parties on their obligation to pay. 
• Effectively follow scripts, guidelines and other tools provided to have professional conversations with liable carrier contacts. 
• Leverage your knowledge and expertise in medical billing/COB/TPL/MSP to review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Initiate applicable action and documentation based upon payment option, actions required if new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.
• Updates company systems with clear and accurate information such as contact and updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates as applicable.
• Initiates activity based upon arrangement with carrier; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
• Escalates accounts for Nurse Case Worker to review as appropriate for complex claims.
• 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 attendance. 
• Follows and complies with company and departmental 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.
• 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.

Other Duties
•Performs other duties as assigned.
 
Why you’ll want to join:
• You want to make a difference for yourself and others.
• You’re not looking for a job, you want a career.
• You learn quickly and are adaptable – we provide paid training.
• You are committed to excellence in all you do – quality and reliability are part of our core values. 
• You want to be part of a team that works hard and celebrates achievement - People are the key to our success. 

Performant offers a competitive benefits package:
• Core health benefits- Medical, Dental and Vision
• Company-paid Life and AD&D
• Other health benefit programs include supplemental Life, AD&D, short-term and long-term disability, •Accident and Critical Illness, Identity Theft, and Flexible Spending Accounts
• Employee Assistance Plan
• Health Advocate Services
• Beyond Work discount products and services
• Additional benefit programs
• 11 paid holidays
• Paid sick leave
• Paid vacation
• 401K program
 
Required Skills and Knowledge:
To perform this job successfully, an individual must be able to perform each essential function satisfactorily.
Below are representative of the knowledge, skills, and abilities required:

• Knowledge and experience with medical claim billing procedures, medical terminology and medical coding, preferably in a role generating, auditing, recovery and/or researching the same involving Worker’s Compensation, Auto Liability and other non-group health plan primary payer liabilities.
• Familiarity with information in forms UB04 and CMS 1500.
• Experience with Coordination of Benefits and Medicare Secondary Payer involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties.  
• Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues.
• Ability to communicate professionally and effectively with providers, carriers, beneficiaries and other audiences regarding claims and billing payment. 
• Experience in handling Medicare and Medicaid claims.
• Protected patients’ privacy, understands and adheres to HIPAA standards and regulations. 
• Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude.
• Ability to share knowledge and educate others on healthcare billing and claims related terminology, procedures, and related information.
• Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
• Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
• Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, etc.).
• Ability to follow process, procedures and regulations in the workplace.
• Ability to effectively perform work independently, and work cooperatively with others to promote a positive team environment.
• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
• Ability to consistently perform job responsibilities.
• Possess a personality type that is ethical, friendly, hard-working and proactive.

Physical Requirements:
Job is in a busy standard office environment with moderate noise level, sits at a desk during scheduled shift, 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 with account holders, may dial manually when need or use dialer system; head-set is also provided.
• Occasionally lift/carry/push/pull up to 10lbs.
 
Education and Experience:
• Minimum 12 months of experience in medical billing experience demonstrating depth of knowledge and capability required for the position. 
• Minimum 3 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills preferably in a healthcare or related industry.
• High School diploma or GED.

Other Requirements:
- Must submit to and pass background check.
- Must not have any Federal or State liens resulting from County, State or Federal tax issues. 
- Must not have any current defaulted student loans.
- Must be able to pass a criminal background checks; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment lists.
- Must submit to and pass drug screen.
- Performant is a government contractor. Certain client assignments for this position may require additional background and/or clearances.

Job Profile is subject to change at any time.

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.
  

Categories

  • Customer Service
  • Financial Services
  • Government
  • Legal
  • Healthcare

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Healthcare Billing Recovery Case Specialist II

Performant Financial
Miami Lakes, FL

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Healthcare Billing Recovery Case Specialist II

Performant Financial
Miami Lakes, FL

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