27 days old

Supervisor, HCS Billing Recovery Quality Assurance (Internal Applicants Only)

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

Supervisor, HCS Billing Recovery Quality Assurance (Internal Applicants Only)
Job Code:2020-50-6-011
Location:Sunrise, FL
Status:Regular Full Time
As the Healthcare Billing Recovery Operations Quality Assurance Supervisor you will be responsible for a team of Quality Specialists (caseworkers) performing audit activity to validate compliance with internal requirements, client contracts, regulatory requirements, and industry quality standards.  This position supports regular reporting and activities required to maintain contract compliance and client expectations, and may serve as “interim Quality Officer” for MSP operations in the absence of the applicable management.

•Provides guidance and leads a team performing casework audits for compliance with departmental, company, regulatory and client requirements and SLAs.
•Ensure staffing and training of team members to properly perform audits, documentation and provide review follow-up to caseworkers and management as appropriate based upon findings. 
•Contribute to development and continuous improvement of operational tools, processes and procedures for quality.
•Contribute to identification and documentation of casework operations change recommendations identified by the quality trends.
•Ensure team consistently achieves established objectives in monitoring and maintaining compliance requirements for MSP casework.
•Leads by example and demonstrates Performant core values in performance of job duties and all interactions.
•Provides feedback, coaching and additional training to assigned team to correct areas of deficiency, as well as performance feedback and skills development to increase capability and effectiveness of specialists.
•Oversee team activities and provide guidance to ensure team actions and documentation on cases are performed in accordance with applicable policies procedures. Perform audits and/or case actions as required.
•Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.
•Ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
•Assists with preparing and presentation of audit review results and reporting to operational leadership and teams, as well as support other activities and projects to support the Quality Officer.
•May perform additional duties to serve as “interim Quality Officer” for MSP operations in the absence of the applicable management if necessary. Such period(s) of designation and scope of duties, if applicable, would be specified.  
•May be required to work some Performant holidays due to client requirement.
•Telework  or work from assigned office as may be required based upon business needs in adherence with Company policies and requirements.
Other Duties
•Performs other duties as assigned.
Required Skills and Knowledge:
•Demonstrated ability to lead and ensure operational results in similar healthcare billing recovery or insurance claim review function.  
•Demonstrated ability to provide guidance in resolving MSP cases in accordance with all requirements. 
•Demonstrated understanding, skills and success in the Quality function providing answers and education to GHP/NGHP community.
•Demonstrated ability to develop approaches and initiates action to improve and grow employee skills and team results.
•Demonstrated ability to inspire and lead a team of operational staff; knowledge of best practices to successfully hire, train, coach, motivate, develop, manage performance and hold accountability of team members.
•Knowledge and experience with medical claim billing procedures, medical terminology and medical coding, preferably in a role generating, auditing, recovery and/or researching the same involving Worker’s Compensation, Auto Liability and other non-group health plan primary payer liabilities.
•Experience with Coordination of Benefits and Medicare Secondary Payer involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties.  
•Proven expertise in gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues, including Medicare and Medicaid claims.
•Demonstrated ability to provide support and guidance to team members in answering questions and concerns from NGHP and GHP community.
•Ability to communicate professionally and effectively with management, staff, client and vendor representatives, providers, carriers, beneficiaries and other audiences regarding claims and billing payment. 
•Demonstrated experience working with operations systems as well as tools and applications for collecting and reporting data, and identifying trends. 
•Protects patients’ privacy, understands and adheres to HIPAA standards and regulations. 
•Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service and servant leadership attitude.
•Ability to share knowledge and educate staff and third parties on healthcare billing and claims related terminology, procedures, and related information.
•Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
•Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
•Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, etc.).
•Ability to follow, teach, and support improvement of process, procedures and workflow.
•Ability to effectively perform deliver results, and work cooperatively with others to promote a positive team environment.
•Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs.
•Ability to consistently perform job responsibilities.
•Possess a personality type that is ethical, friendly, hard-working and proactive.
•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.
Education and Experience:
•Bachelor’s Degree in Business, Management, Information Systems, Finance, Healthcare Administration, or related (or equivalent combination of education and experience)
•Some college in medical terminology, billing, coding or Medical Billing/Coding certification preferred.
•Quality certification, such as ASQ, a plus
•Minimum 2 years of relevant experience as a supervisor, lead or other position with oversight, escalation, and/or review responsibilities.
•Minimum 5 years progressive relevant experience in the healthcare/medical billing industry demonstrating depth of knowledge and capability required for the position. 
•Relevant quality experience demonstrating depth of knowledge and capability required for the position. 
•Incumbent qualifications/resume must be approved by client for “interim Quality Officer” designation.

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.
Other Requirements:
•Must submit to and pass pre-hire background check, as well as additional checks throughout employment
•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. 



Posted: 2020-06-11 Expires: 2020-07-10

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Supervisor, HCS Billing Recovery Quality Assurance (Internal Applicants Only)

Performant Financial
Sunrise, FL

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