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

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

Essential Duties Work closely with the operations teams and data team to ensure inventory is accurately and efficiently distributed/assigned and transferred across teams based upon applicable inventory type workflow and requirements. Conduct auditing of operations team activities on inventory to validate compliance with internal requirements, client contracts, regulatory

Work closely with the operations teams and data team to ensure inventory is accurately and efficiently distributed/assigned and transferred across teams based upon applicable inventory type workflow and requirements. Conduct auditing of operations team activities on inventory to validate compliance with internal requirements, client contracts, regulatory requirements, and

Review eligibility and other documentation to verify current payer order of benefits. Leverage your knowledge and expertise in COB/TPL to review eligibility, investigate the policy coverage to determine proper order of benefits and answer questions and/or provide information that will bring to successful payment or other appropriate account action. Ability to identify tre

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

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

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

Essential functions Responsible for the engineering (design, implementation, maintenance, and continuous improvement) of the desktop environment including system management tools. Desktop image and application package creation Enterprise wide application and software update deployments Identify departmental needs and make suggestions regarding technical direction. Produce

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

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

Candidates possessing both analytic prowess and business acumen, along with project coordinator and management skills would be best suited for this dynamic, fast paced role that affords great exposure to a variety of business units and initiatives within the company. Monitors and analyzes internal and external reports for assigned clients or business segment and takes nec

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

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

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