8 hours

Healthcare Services Segment Specialist - Data Mining & Analysis

Performant Financial
Sunrise, FL
  • Job Code
Performant Financial Corporation
Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

Healthcare Services Segment Specialist - Data Mining & Analysis
Job Code:2019-50-6A-046
Location:Remote - Sunrise, FL
Status:Regular Full Time
This Healthcare Services Segment Specialist position applies specific subject matter expertise in Data Mining & Analysis to support of audit business activity performing the following essential duties:

–Development of coding and new payment integrity concepts for data mining to be applied and deployed for Performant’s government and/or commercial client base. Including but not limited to research, data analysis and documentation.
–Develop measures to carry out healthcare services data analysis using clinical and diagnostic classification and medical condition-based reporting.
–Evaluates the output of data queries, integrating data from multiple sources, to identify trends, quantify opportunities of recovery, and transform this data into usable information.
–Contribute to the creation of new analytical methods and models, if necessary.
–Identify, interpret and apply policy in concept development or program consultation. Stay abreast of industry policy and guidelines.
–Be able to QA and probe audit concept request after submitting to analytics team and determine if the language of the concept was converted correctly to pull appropriate claims for review.
–Evaluate existing coding guidelines and make recommendations to improve finding rates, reduce dispute/appeal rates and decrease overturn rates.
–Data Analysis using clients’ data including but limited to contracts, claims, enrollment, coordination of benefits, billing guidelines, clinical, administrative, medical, pharmacy, etc.
–Identify trends in the data and payment integrity opportunities for recovery.
–Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs Fraud Waste & Abuse (FWA) Leads & Medicare vs Medicaid vs Commercial)
–Prepares project status reports by collecting, analyzing and summarizing information on trend.
–Works very closely with other team members to ensure on time project deliverables.
–Works independently and manages own projects to meet time and resource budgets and to deliver on-time.
–Performs other duties as assigned and required to meet business needs
Required Skills and Knowledge:
-Demonstrated expertise (depth and breadth) of knowledge of Inpatient and Outpatient Coding – such as Current Procedural Terminology (CPT), Medicare Severity-Diagnosis Related Group (MS-DRGs), International Classification of Diseases, 10th revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) codes and Healthcare Common Procedure Coding System (HCPCS).
-Demonstrated expertise (depth and breadth) of National Correct Coding Initiative (NCCI) Edits, Local Coverage Determinations (LCD’s) and National Coverage Determinations (NCD’s), FWA, Medicare guidelines.
-Strong knowledge of healthcare revenue cycle
-A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology. 
-Strong technical skills
-Data Mining and Analysis
-Clinical setting experience a plus
-Strong skills in Relational Databases and SQL
-Strong knowledge in coding software, TruCode knowledge a plus
-Strong interpersonal skills; ability to communicate with all levels within the organization and with diverse teams
-Excellent written and verbal communication skills
-Good critical thinking, questioning, and listening skills; excellent attention to detail.
-Strong critical thinking and analytical skills.
-Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames.
-Advanced Microsoft suite skills, such as – Excel, Word, Access, Outlook and SharePoint. 
Education and Experience:
-Bachelor's degree in related field or equivalent experience.
-Previous healthcare data mining experience
-Must have IP & OP coding experience
-RN license a plus
-Must have active or inactive coding certification such as: Certified Professional Coder (CPC), Certified Outpatient Coder (COC) (formerly CPC-H, CPC-P), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS) and Certified Coding Specialist-Physician-based (CCS-P).
-Minimum of 8+ years healthcare payer experience
-Experience with JIRA

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 check; must not have any felony convictions or specific misdemeanors.
-Must submit to and pass drug screen.

Job Profile is subject to change at any time.

Performant Financial Corporation is a government contractor and 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.


Posted: 2019-12-08 Expires: 2020-01-07

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Healthcare Services Segment Specialist - Data Mining & Analysis

Performant Financial
Sunrise, FL

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