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 Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most - quality of care and healthier lives for all.

If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture - then Performant is the place for you!

ABOUT THE OPPORTUNITY:

As a member of our medical audit team, theOutpatientMedical Coding Auditor IIwill have an opportunity to make direct contributions to the company's bottom line in our rapidly growing healthcare business. You will have the opportunity to leverage your coding knowledge and medical claims experience to identify client records with billing coding issues as well as investigative and auditing opportunities.

You will help identify and refine new issues for Performant to present to our clients for audit strategy, proof of concept development, and assist in developing training material or assist in training for new issues. You must possess a unique blend of medical coding experience, business aptitude and understanding of payables/receivables, commitment to excellence, critical eye for quality and accuracy, team spirit and the self-drive to meet and exceed productivity goals.

Key Responsibilities:

• Objectively 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 review and disposition of suspected case referrals, including determination of inaccurate and/or inappropriate coding.

• Appropriately refer reviews for clinical validation and provide communication and guidance for other Medical Review staff on needed documentation or clarification on coding and/or billing requirements.

• Enter and update all contract and/or review findings and supporting documentation into the audit processing system.

• Write logic/parameters for system edits to detect incorrect coding over-payments, aberrant and abusive coding patterns.

• Proof of concept development and data analysis of reports for potential edit development.

• Monitor CMS and major payer coding and reimbursement policies.

• Assist in identifying new issues/investigative strategies for audit, perform research to validate new issues, and provide new rules, regulations and applicable Medicare or program language and explanation.

• Maintain a current knowledge of all Medicare and Commercial regulations, policies, and procedures, as well as requirements defined in assigned client(s) Statement(s) of Work (SOW).

• Maintain certifications and training required to ensure eligibility to perform audits on behalf of Performant such as coding certification(s), as well as HIPPA and other compliance training provided by Performant and client(s).

• Develop and maintain professional working relationships within the department and cross-functionally.

• Notify management of all correspondence indicating displeasure with the Remittance Advice (RA), in the over-payment identification, or in the recovery methods utilized, legal action, orgovernment intervention.

• Assist in developing material for training and facilitate or assist in audit training sessions.

• Assist in educating Performant team members on coding, policies, regulations, appeal strategies, etc. as needed.

• Perform miscellaneous duties as assigned required to meet business needs in a highly professional manner.

• Other duties as assigned.

Knowledge, Skills, and Abilities Needed:

• Possess knowledge of CMS rules and regulations

• Proficient in the use of MCS 1500/UB 04 forms

• Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10, MS-DRG coding

• Working knowledge of encoder

• Proven ability to review, analyze, and research coding issues.

• Reimbursement policy and/or claims software analyst experience.

• Familiarity with interpreting electronic medical records (EHR)

• Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing.

• Courteous, professional, and respectful attitude

• Adaptability of skills to handle any non-standard situations that may arise or apply skills in new ways as may be required to meet business needs.

• Ability to multi-task effectively and work independently in a remote setting

• Attention to detail.

• Excellent written and verbal communication skills

• Typing skills, comfortable navigating and using desktop technology, as well as working knowledge of MS Office applications (Outlook, Word, Excel).

Required and Preferred Qualifications:

• Active Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P required.

• High School Diploma or GED is required.

• At least three years of direct experience in coding/auditing outpatient services, and medical chart review for all provider/claim types for outpatient facility.

• Coding for emergency care, observation, and same day surgery highly desired.

• Prior auditing experience desirable in either a provider setting, or payer experience in claim processing, edit development, and/or coding and reimbursement policy a plus.

• Previous payer experience in a claim processing, edit development, and/or coding and reimbursement policy a plus.

WHAT WE OFFER:

Performant offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, as well as sick time and vacation time off annually. For more information about our benefits package, please refer to our benefits page on our website or ask your Talent Acquisition contact during an interview.

Physical Requirements & Additional Notices:

If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee's responsibility to maintain this Internet access at their home office location.

The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.

• Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.

• Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).

• Regularly sit/stand 8 or more hours per day.

• Occasionally lift/carry/push/pull up to 10lbs.

Performant is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:

• Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.

• Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.

• Must complete the Performant Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.

• Other requirements may apply.

All employees and contractors for Performant Financial may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Performant's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

Performant is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Performant will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Performant's Human Resources team to discuss further.

Our diversity makes Performant unique and strengthens us as an organization to help us better serve our clients. Performant 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.