2 days old

Healthcare Services Segment Specialist - Post Acute Care

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

Healthcare Services Segment Specialist - Post Acute Care
Job Code:2019-50-6A-047
Location:Remote - Sunrise, FL
Status:Regular Full Time
This Healthcare Services Segment Specialist position applies specific subject matter expertise in 
Post-Acute Care (PAC) Coding to support of audit business activity performing the following essential duties:

–Provide leadership of PAC Coding auditing strategy as per each unique contract.
–Create and/or 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
–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 Fraud, Waste & Abuse (FWA) Leads & Medicare 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 PAC claims, as necessary
–Participate in calls with providers/client representatives as a representative on behalf of Performant to review audited PAC claims, as necessary
–Support strategic PAC Coding auditing market development by attending sales meetings and other industry specific events.
–Be able to QA and probe PAC Coding 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.
–Explain to audit team what PAC coding audit concept was created and how to review claims that are pulled from that audit concept. 
–Develop and conduct and/or support training of analytic, audit and clinical staff as necessary
–Works very closely with other team members to ensure on time project deliveries. 
–Performs other duties as assigned and required to meet business needs
Required Skills and Knowledge:
-Demonstrated expertise (depth and breadth) of knowledge of PAC claims – such as MS-DRG, ICD-10-CM and ICD-10-PCS.
-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.
-Strong Microsoft suite skills, such as – Excel, Word, Outlook and SharePoint.

Education and Experience:
-Bachelor's degree in related field or equivalent experience
-Must have PAC coding experience
-RN license a plus
-Inpatient or Outpatient Coding Certificate a plus
-Minimum 8+ years of progressive experience in healthcare claim type subject matter specialty specific to the position
-Experience must include creation of concepts for healthcare audits in relation to outpatient claims. A broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, medical necessity criteria and coding terminology. 
-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.

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: 2020-04-02 Expires: 2020-05-02

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Healthcare Services Segment Specialist - Post Acute Care

Performant Financial
Sunrise, FL

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