20 days old

Healthcare Third Party Liability Regulatory Specialist

Sunrise, FL 33351
Regular Full Time

The TPL Regulatory Specialist supports Performants Healthcare team by providing research, insights, and recommendations with laws and regulations related to Performants Eligibility and Claiming Integrity Services.

Essential Duties/Responsibilities:

Identify, research, understand state and Federal laws and regulations that impact Performants eligibility and claiming integrity products and services
Collaborate with and provide recommended actions to senior management in addressing potential legal and/or regulatory roadblocks to business objectives
Identify, track, and document significant government and private stakeholders in the eligibility marketplace in order to:
  oContact and establish collaborative eligibility and claim data sharing relationships
  oNegotiate data-sharing, trading partner, and other necessary agreements 
  oProactively resolve concerns, disputes, and escalations
Remain informed of legal changes, guidelines, and judgments from healthcare industry that could impact Performants Healthcare 
Support Healthcare Operations with ad hoc scenarios where regulations, state laws, or Federal laws intersect, including general escalation assistance for operational issues and/or disputes
Collaborate with Performants General Council, Compliance, and senior business leadership in drafting and refining contracts, policies, procedures, and other business collateral
Propose healthcare operational or relational enhancements to the organization from a legal or regulatory perspective, included but not limited to the Third-Party Liability (TPL) and Reclamation teams, Medicare Secondary Payer (MSP), and Coordination of Benefits (COB).
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.
Other duties as assigned


Required Skills and Knowledge:
Working knowledge of healthcare financials and how legal, compliance, and regulatory requirements and guidelines affect recovery and eligibility management
Proficient in MS Word and Excel
Intermediate skills in litigation, transcript databases
Strong written and verbal communication skills
Exceptional research skills, analytical ability and keen attention to detail 
Highly skilled in documentation and text analysis applicable for the role
Ability to manage multiple, and sometimes conflicting, priorities and meet deadlines

Physical Requirements:

Performs duties in a busy standard office environment with moderate noise level or may work remotely from home-office as may be required based upon business needs, in accordance with company policies & procedures.
Sits or stands at a desk during scheduled shift, reaching as needed to use office equipment.
Makes and returns 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).
Types frequently, but not constantly, using a keyboard and mouse.
Occasionally lifts/carries/pushes/pulls up to 10 pounds.
Travel as required to meet business needs.


Education and Experience:
Juris Doctorate degree required
5+ years of legal research experience
3+ years in Healthcare claims or revenue cycle
Extensive experience working with Healthcare payers and related regulatory bodies


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. 




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Posted: 2020-08-31 Expires: 2020-10-18
Analytics, audit, and recovery services for healthcare, government and student loans.

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Healthcare Third Party Liability Regulatory Specialist

Performant Financial
Sunrise, FL 33351

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