Healthcare Billing Recovery Case Specialist I (SCA)

Machinify • Lathrop, CA

3d • $19 - $20 • Hybrid

About The Position

As a Healthcare Billing Recovery Outreach Specialist I (SCA), you are assigned health insurance carrier, auto/home/worker’s comp insurance carrier, or legal representatives (“stakeholders”) of Group Healthcare (GHP) and/or Non-Group Healthcare Provider (NGHP) cases under the CMS Medicare Secondary Recovery Program. The Outreach team works with the Medicare Secondary Payer (“MSP”) Debtor stakeholder community for Performant’s assigned cases to address their high priority questions and concerns regarding MSP case demands and related MSP correspondence. In addition, the Outreach team provides education and feedback to this MSP stakeholder community to help them understand the full scope of Performant’s responsibilities and operating processes, as well as the stakeholder’s corresponding responsibilities to ensure that MSP debts are paid timely and accurately.

Requirements

• Knowledge and experience with medical claim billing procedures, medical terminology and medical coding (including information in forms UB04 and CMS 1500), preferably in a role generating, auditing, recovery and/or researching the same including Medicare and Medicaid claims.
• Experience with Coordination of Benefits (COB), Third Party Liability (TPL), Medicare Secondary Payer (MSP) with 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 successfully complete high-quality MSP GHP and NGHP casework in accordance with company, client (CMS) and regulatory requirements.
• Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude and approach.
• Demonstrated professional verbal and written communication skills to communicate professionally and effectively with internal audiences at all levels as well as externally with providers, carriers, beneficiaries and other audiences regarding claims and billing payment.
• Protected 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 attitude.
• Self-motivated and thrives in a fast-paced business operations department 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, individual coaching, etc.).
• Ability to follow process, procedures and regulations in the workplace.
• Ability to effectively perform work independently, and work cooperatively with others to promote a positive team environment.
• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
• Ability to consistently perform job responsibilities.
• Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
• Completion of Teleworker Agreement upon hire, and adherence to the Agreement (including applicable policies and procedures), which includes, but not limited to, basic home office suitability requirements such as high-speed internet connectivity, appropriate workspace for compliance with confidentiality, HIPAA, safety and ergonomics, and work environment allowing dedicated work-focus without distraction during work hours.
• Possess a personality type that is ethical, friendly, hard-working and proactive.

Nice To Haves

• After 3 months You will have a strong understanding of the role. You begin building relationships and collaborating with peers. You develop effective time and priorities management. You receive initial feedback about your performance and are using it to improve. You’ve gained confidence in your abilities and are starting to feel more comfortable in your role.
• After 1 year You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency. You have established a strong network of internal relationships and are recognized as a key collaborator. You’ve been entrusted with greater responsibility, indicating the company’s confidence in your abilities. You see opportunities for career progression and personal development.

Responsibilities

• Leverage your knowledge and expertise in TPL/COB/MSP to review case documentation and any previous case work and activities completed by caseworkers to validate liability, responses to defenses regarding payment liability, status the account and letter correspondence, etc. in preparation to respond to and/or reach out to stakeholders.
• Answer questions (on the phone and/or in writing as appropriate) and/or provide information and education to the stakeholder(s) that will bring to successful payment or other appropriate account action.
• Responsible for monthly Outreach calls for assigned stakeholders which includes creating agendas, taking meeting minutes and responding to all phone calls or email inquiries.
• Initiate correct action with applicable party and documentation based upon payment option, actions required if review of case and/or new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.
• Updates client and/or company systems with clear and accurate information such as involved party(ies) contacting the CRC, notes from contact dialog, as well as account status updates as applicable.
• Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
• 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.
• Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
• Follows and complies with company, departmental and client program policies, processes and procedures.
• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
• Successfully completes, retains, applies and adheres to content in required training as assigned
• Consistently achieve or exceed established metrics and goals assigned, including but not limited to, production and quality.
• Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and, successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.)
• Demonstrates Performant core values in performance of job duties and all interactions.
• Correct areas of deficiency and oversight received from quality reviews and/or management.
• Work overtime as may be required.
• May be required to work some Performant holidays due to client requirement.
• Performs other duties as assigned.

Benefits

• FTO, Paid Holidays, and Volunteer Days
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED