5 hours

Healthcare Billing & Recovery QA Program Specialist

Performant Financial
Sunrise, FL
  • Job Code
Performant Financial Corporation

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

Healthcare Billing & Recovery QA Program Specialist
Job Code:2018-50-6-016
Location:Sunrise, FL
Status:Regular Full Time

The Healthcare Billing & Recovery QA Program Specialist develops and maintains the Quality Assurance function to validate and optimize operational activity and output is in accordance with client contractual obligations, company and regulatory requirements, as well as industry quality standards. In addition, this position will provide insight and recommendations to business leaders and may directly or indirectly lead non-exempt staff performing conducting transactional audits and reporting on applicable testing.

• Ensure resources are adequate to company demands & meeting any/all deadlines, and resolution to client matters and issues attributable to QA.
• Lead Quality function to ensure company compliance with departmental, company, regulatory and client requirements and SLAs for assigned scope.
• Evaluate client contract SOWs and participate in implementation/change management activities to identify and implement quality assurance programs for applicable business and client requirements.
• Document and formalize policy and procedure practices to be followed by staff performing transactional audit activity.
• Conduct assessments to ensure that operations teams are complying with contracts, regulations, and policies. 
• Develop and provide written reports containing audit/review results. 
• Present audit/review results to applicable Healthcare Recovery Program and Operational management.
• As directed, work with applicable internal business groups to ensure that Standard Operating Procedures are accurate and adequately documented to ensure clarity of policy and work instructions in accordance with SOW, regulatory and company requirements, and best practices for optimal operational results; recommended changes and updates to work instructions as needed to document changes to client or regulatory requirements, to create efficiencies and/or best practices. 
• Collaborate with Learning & Development regarding changes to SOPs that impact required changes to training materials and approaches, as well as needs for retraining and/or additional training tools to correct or enhance operational output. 
• Play key role in process for obtaining and maintaining quality certifications such as CMMI, as well as applicable internal or external audit activities for such certifications.
• Leads and drives various projects as assigned by management. 
• Perform other incidentals and related duties as required and assigned.

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. 
• Solid business acumen and specific industry knowledge, 
• Strong analytical and critical thinking abilities. 
• Able to review and analyze reports and information from disparate sources and form logical conclusions and applicable functional requirements.
• Excellent written and verbal communication skills ability to communicate with all levels within the organization and external clients. 
• Strong foundational knowledge of terminology, regulations and operational practices for government and commercial healthcare medical billing & collections industry, including Medicare/Medicaid, Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP)  and procedural challenges regulations; experience generating or auditing medical  bills; and interpreting Explanation of Benefits (EOB).
• Protected patients’ privacy, understands and adheres to HIPAA standards and regulations. 
• Remarkable interpersonalskills; ability to listen, be succinct and demonstrate positive customer service and servant leadership attitude.
• Working knowledge of establishing and managing quality certifications and related infrastructure such as CMMI preferred.
• Possess ability to lead in a team environment where collaboration to solve problems, generate solutions and the knowledge transfer process are critical for success. 
• Demonstrates excellent judgment; anticipates consequences of actions and weighing multiple, sometimes conflicting, priorities. 
• Acts with confidence, makes good decisions in the best interest of the company and drive results given direction in the form of assigned goals or objectives. 
• Able to solve complex problems, and resolve disagreements with informed, rational debate. 
• Mind-set of continuous improvement, learns and adapts quickly to change; impact positively in a fast-paced and dynamic environment.
• Experience leading, coaching, and training non-exempt staff. 
• Solid project management skills with experience managing multiple projects, as well as direct and indirect resources concurrently. 
• Able to maintain confidentiality of sensitive data. 
• Comprehensive computer skills; skilled at operating/utilizing MS Office applications to include Excel, Word, PowerPoint, and ability to quickly learn new proprietary and client applications.
• Solid understanding and ease leveraging data systems and account workflow systems. Experience leveraging QA applications and systems highly desired. 

Physical Requirements:
• Job is in a busy standard office environment with moderate noise level, sits at a desk during office hours, uses office phone system; views a computer monitor, types on a keyboard and uses a mouse.  
• Sit approximately 85% of the day. 
• Stand/walk approximately 15% of the day. 
• Occasionally lift/carry/push/pull up to 10lbs. 
• Consistently viewing a computer screen and keyboard frequently up to 75% of time. 
• Communicates frequently on the phone with internal and external contacts; head-set may be provided upon request. 

Education and Experience:

• Bachelor’s Degree in Business, Management, Information Systems, Finance, or related (or equivalent combination of education and experience)
• Quality certification, such as ASQ, highly desired.
• 10+ years progressive experience in relevant medical billing/recovery, and/or quality/compliance functions.
• 4+ years in a role with some oversight responsibility of recovery, medical billing, and/or quality operations of the same.
• Experience establishing and managing audit policy and procedures, and experience with quality assurance, and/or compliance requirements and infrastructure.   
• Specific experience with Medicare Secondary Payer highly desired. 
• Experience evaluating, documenting and restructuring workflow and procedures, involving cross-functional activities and systems. 
• Experience reviewing contractual, regulatory, and procedural documents, and leveraging to develop and execute assessment tools, criteria and reporting.  
• Experience in role with similar scope of responsibilities, with proven track record 

Other Requirements:
- Must submit to and pass background check. 
- Must not have any current defaulted student loans.
- Must not have any Federal or State liens resulting from County, State or Federal tax issues.
- Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors.
- Must submit to and pass drug screen.

Performant is a government contractor. Certain client assignments for this position may require 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.

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. 



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Healthcare Billing & Recovery QA Program Specialist

Performant Financial
Sunrise, FL

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Performant Financial
Sunrise, FL

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