27 days old

Healthcare Services Segment Specialist - DME (Commercial)

Sunrise, FL 33351
Regular Full Time


The Health Care Services Audit Concept Specialist applies specific subject matter expertise in the Durable Medical Equipment (DME) to support of audit business activity performing the following essential duties:

-Support the responses to provider/client representative from written inquiries as it pertains to audited DME claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of  Performant to review audited DME claims, as necessary
-Support strategic DME market development by attending sales meetings and other industry specific events.
-Provide leadership of DME audit strategy as per each unique contract.
-Review audit concepts & help determine alignment/adjustment according to line of business and client policy
-Evaluate existing audit guidelines and make recommendations to improve finding rate, reduce dispute/appeal rate and decrease overturn rate
-Develop or rewrite review guidelines, as necessary
-Develop and conduct and/or support training of analytic, audit and clinical staff as necessary
-Identify, interpret and apply policy in concept development or program consultation. Stay abreast of industry policy
-Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial)
-Participate in and support statistical analysis to drive scoring and selection for new audit concepts
Support the responses to provider/client representative from written inquiries as it pertains to audited claims, as necessary
-Participate in calls with providers/client representatives as a representative on behalf of  Performant to review audited claims, as necessary
-Works very closely with other team members to ensure on time project deliveries. 

Other Duties

*Performs other duties as assigned and required to meet business needs.

Required Skills and Knowledge:
  • Demonstrated expertise (depth and breadth) of knowledge of DME claims
  • 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.
  • Desired Technical Knowledge and Experience

Physical Requirements:

Sit/stand/walk 8-12 hours/day
Lift/carry/push/pull under and over 10lbs occasionally
Keying frequency, handling, reaching, fine manipulation

Education and Experience:
  • Bachelor's degree in related field or equivalent experience
  • Minimum 8+ years of progressive experience in healthcare claim type subject matter specialty specific to the position
  • Progressive health care data analysis experience including gathering and documenting requirements for projects of all sizes

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.

Reasonable Accommodations may be made to enable individuals with disabilities to perform the essential functions.

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.



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Posted: 2020-06-11 Expires: 2020-08-07
Analytics, audit, and recovery services for healthcare, government and student loans.

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Healthcare Services Segment Specialist - DME (Commercial)

Performant Financial
Sunrise, FL 33351

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