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Performant Healthcare, Inc. · 3 months ago

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

United States

Full-time

Remote

Entry, Mid Level

$90K/yr - $105K/yr

2+ years exp

Performant Healthcare, Inc. is a leading independent healthcare payment integrity company focused on helping clients achieve their goals through technology-enabled services. The Healthcare Services Concept Specialist will provide support in maintaining and developing audit concepts, particularly within the MolDX space, leveraging extensive experience in molecular diagnostics and claims auditing.

AnalyticsCustomer ServiceFinancial Services

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 (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 coordinate) as necessary for changes to existing concepts. -May contribute to development of training materials and tools for new concepts

Conduct research, identify impact on existing concepts, and document accordingly (may support Segment specialists with research for new concepts)

Interpret and apply policy in existing concept review/updates or ask may be requested in support of Segment Specialists for new concepts

Support activities required to “package” concepts, including, but not limited to, pulling together necessary documents, and supporting data in appropriate order and locations, coordinating activities and documenting process steps, proofing documents, and tracking/reporting status

Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial)

Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance with high degree of accuracy and quality providing status reports and deliver results on-time

May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims, as necessary

Stay abreast of industry policy

Works very closely with other team members to ensure on time project deliveries, cross train, and knowledge transfer, and maintain required quality and productivity standards

Performs other duties as assigned and required to meet business needs

Qualification

Medicare policy knowledgeICD-10-CM/PCS codingCPT-4 codingHCPCS codingClaims auditing experiencePayment Integrity experienceMicrosoft Office proficiencyVerbal communicationWritten communicationCritical thinking skillsTime management skillsFlexibilityAdaptability

Required

At least 10 years of experience in molecular diagnostics and a strong background in claims auditing

At least 2-4 years of audit or Payment Integrity experience

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

Demonstrated knowledge of applicable Medicare and Commercial policy and claims process, and ability to research and analyze the same, to successfully perform the job

Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding

Knowledge of the national coding standards, particularly payment rules

Knowledge of Medicare and commercial claims processing systems

Ability to understand and apply complex policies, procedures, regulations, and legal statutes

Strong verbal communication and interpersonal skills; ability to communicate with all levels within the organization and with diverse teams

Excellent written communication skills; including proofing and editing

Good critical thinking, analytical, questioning, and listening skills; excellent attention to detail

Flexibility to handle non-standard situations as they arise; and adaptable to changing business needs in a fast-paced dynamic environment

Time management skills for managing multiple tasks simultaneously, while completing work within allocated time frames

Strong proficiency in Microsoft Word, Excel, SharePoint (advanced skills highly desirable), and easily learns and adapts to new applications and systems