Healthcare Services Concept Specialist (RN and/or Professional Coder) - MolDX Focus

Performant Corp • Plantation, FL

97d • $90,000 - $105,000

About The Position

The Healthcare Services Concept Specialist provides support to assigned Segment Specialists by maintaining current audit concepts as well as provide support for the development process of new audit concepts. This opening will be focused on creating audit concepts within the MolDX space. Ideal candidates will have at least 10 years of experience in molecular diagnostics and a strong background in claims auditing.

Requirements

• At least 2-4 years of audit or Payment Integrity experience.
• Demonstrated knowledge of applicable Medicare and Commercial policy and claims process.
• Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding.
• Knowledge of the national coding standards, particularly payment rules.
• Ability to understand and apply complex policies, procedures, regulations, and legal statutes.
• Strong verbal communication and interpersonal skills.
• Excellent written communication skills, including proofing and editing.
• Good critical thinking, analytical, questioning, and listening skills.
• Strong proficiency in Microsoft Word, Excel, SharePoint.

Nice To Haves

• CPC, COC, RHIA, or RHIT certification and/or RN.

Responsibilities

• Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes.
• Collaborates with and leverages Segment Specialist expertise to ensure on-point results.
• Ensure training material updates as necessary for changes to existing concepts.
• Conduct research, identify impact on existing concepts, and document accordingly.
• Interpret and apply policy in existing concept review/updates.
• Support activities required to 'package' concepts, including pulling together necessary documents and supporting data.
• Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance.
• May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims.
• Stay abreast of industry policy.
• Works closely with other team members to ensure on-time project deliveries.

Benefits

• Medical, dental, vision, disability coverage options.
• Life insurance coverage.
• 401(k) savings plans.
• Paid family/parental leave.
• 11 paid holidays per year.
• Sick time and vacation time off annually.

What This Job Offers

• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees