11 days old

HCS Customer Service Specialist II - temporarily remote in Lathrop, CA area

Lathrop, CA 95330 Work Remotely
Regular Full Time
   

Responsibilities:

***NOTE COVID-19***: 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.

Customer Service Specialists focused on Performants commercial healthcare client contracts are the primary points of contact for all providers, payers, etc. They respond to all inquiries and provide supporting documentation. In addition, they conduct improper claims payment recovery efforts. 



***NOTE COVID-19*** 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.

Essential duties:

Facilitate and process requests from and/or to the Performant Team
Make necessary contacts and/or perform necessary research to validate provider contact information
Contact healthcare providers on overpaid claims and maintain collection records and account status updates
Develop professional working relationships with colleagues, healthcare providers, payers, and other applicable third-parties
Establish good contact with providers to guarantee proper claim presentation and follow up
Enter and update all contact and activity information into the applicable Performant system where not automatically completed by the system, e.g., a telephone call is made, recorded, and attached to the case file in the system, but the outcome must be extracted from the call and input into system
Notify management of:  
    -all correspondence indicating displeasure with the Payer, in the overpayment identification, or in the recovery methods utilized; 
    -legal action; 
    -government intervention;
    -escalated concerns regarding audit issues and edit parameters; 
    -suggestions to improve or correct processes or documents

Research and route internal/external communications to the appropriate person or department, including referrals and documents, calls, and faxes
Conduct critical due diligence follow-ups of unread media
Answers questions from providers and resolves issues via phone and written correspondence
Educating providers on their appeal rights
Communicate with other staff/departments as necessary 
Maintain a current knowledge of all applicable rules, regulations, policies and procedures related to assigned client programs
Maintain current knowledge of all applicable contract requirements and objectives based upon assignment
Maintain HIPAA Certification
Conduct simple coding reviews
Perform miscellaneous duties as assigned in a highly professional manner

*Note - 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 Performants policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
Required Skills and Knowledge:
Thorough working knowledge of CPT/HCPCs/ICD-9 coding
Excellent verbal and written communication skills
Skilled in data entry and knowledge of computers
Courteous, professional, and respectful attitude
Strong understanding of customer service policies and processes
Provider customer service background
Basic understanding of accounts payable and receivable
Possess knowledge of applicable rules and regulations
Claims processing and/or billing experience
Proficient in the use of HCFA/UB forms
Flexibility to handle any non-standard situations that may arise
Must be able to multi-task
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 in a busy standard is performed in an 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:

4+ years Medical claims processing, and/or medical customer service
2+ years claims billing
Hospital billing experience preferred
High School diploma or equivalent


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
   


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Posted: 2020-11-13 Expires: 2020-12-24

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HCS Customer Service Specialist II - temporarily remote in Lathrop, CA area

Performant Financial
Lathrop, CA 95330

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