Maintain a current knowledge of all contract requirements and objectives. Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors. Take inbound calls from providers to answer questions and resolve complex issues. Make outbound calls to healthcare providers as a courtesy to confirm if letters requesting records for re

Leverage knowledge and expertise in COB/TPL/MSP to gather and review documentation and eligibility information, investigate the file to determine proper order of benefits when multiple forms of coverage are available, and resolve primacy issues. Demonstrate ability to routinely identify and solve non standard and often complex data or record discrepancies and/or issues an

Responsible for overseeing all financial functions for Performant and its subsidiaries, including all internal and external financial reporting. Works with CFO to establish responsibilities and procedures for attaining financial objectives. Approach daily work with an FP&A mindset, and work on deals of all types M&A, Vendors, Lenders, and Investors (in partnership with In

Maintain a current knowledge of all contract requirements and objectives. Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors. Take inbound calls from providers to answer questions and resolve complex issues. Make outbound calls to healthcare providers as a courtesy to confirm if letters requesting records for re

Performs analysis as required to support product development of both systems and components. Able to work independently on significant project components with minimal supervision and direction. Conducts analysis substantiating designs and iterates with system, project, and design engineering staff to optimize system and component designs Recommends technical decisions on

ly and accurately conduct coding reviews on medical records for assigned client audit contract in accordance with the statement of work while meeting compliance, productivity, and quality expectations. Conduct review of flagged claims and Fraud Waste & Abuse (FWA) referrals involving suspected upcoding, unbundling, anomalous coding, intentional miscoding, etc. Timely revie

ABOUT PERFORMANT At Performant, we're focused on helping our clients achieve their goals by providing technology enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and

Ensure that all deadlines are met, as dictated by client contracts, department & company policies and any/all regulatory or compliance requirements. Review all incoming mail, prioritizing by urgency and importance as per department & client guidelines. Process and scan all correspondence efficiently and accurately. Upload media to accounts and ensure uploads are successfu

Perform duties such as review and process various types of transactions, conduct data validation, data entry, and/or other process type functions Responsible for creation of daily, weekly, monthly, quarterly and annual reports for internal and external distribution. Track various regular file transmissions to ensure transactions are completed regularly, report files with

Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. Document all findings referencing the appropriate policies and rules. Generate letters articulating audit findings. Supporting your findings during the appeals process if requested. Working collabor

Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly). Collaborates with and leverages Segment Specialist expertise to ensure on point results. Ensure training material updates (may develop or coo

Lead by example through achieving excellent performance results, as well as compliance, attendance and behavior. Provides answers and handles escalation from team members Assist management in developing tools and/or communicating changes in requirements, systems, processes and procedures, as well as supports transition and adaptation by the team in a positive and effectiv

ABOUT PERFORMANT At Performant, we're focused on helping our clients achieve their goals by providing technology enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and

Review account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error. Leverage your knowledge and expertise in medical billing/COB/MSP to review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and

Interpret provider contract payment information for use by the complex and automated teams Develop logic for queries to identify inappropriate payments Analyze data results to ensure accuracy of contract interpretation and system loads Create and process system files, and needed workflows using available tools, specific layouts, conditions, and instructions to create over