Performant Healthcare, Inc. · 8 hours ago
Healthcare Documentation Auditor
United States
Full-time
Remote
Mid, Senior Level
$19/hr - $21/hr
2+ years expPerformant Healthcare, Inc. is a leading healthcare intelligence company that focuses on delivering value and efficiency to health plans. The Healthcare Documentation Auditor is responsible for reviewing documentation and billing accuracy for claims on behalf of Government and Commercial Payers.
AnalyticsCustomer ServiceFinancial Services
Responsibilities
Review medical records for services billed and validate required documents and information is contained within the records submitted for various service types as required by clients
Applying local coverage determination (LCD), national coverage determination (NCD), and commercial payer policy to services in review
Document and articulate review findings and reference the appropriate policies and rules in the audit platform and as rationale language
Working collaboratively with the audit team to identify vulnerabilities and/or cases subject to potential abuse
Keep abreast of changes in technology and regulatory issues that may affect our business and clients
Suggest ideas that may improve audit workflows
Participate in the development of Review Guidelines and meetings as necessary
Cross-train in other audit types/focus areas or management teams as applicable
Maintain required quality and productivity standards
Performs other duties as assigned
Qualification
Required
High School Diploma or GED is required
Familiarity with insurance programs, particularly the coverage and payment rules, and audit types to validate against orders, units, and signatures
Demonstrated knowledge of medical terminology
Ability to maintain high-quality work while meeting strict deadlines
Excellent written and verbal communication skills
Must be able to independently use standard office computer technology (e.g., email telephone, copier, etc.) and have experience using a platform to review and document findings
Must be able to manage multiple assignments effectively, organize and prioritize workload, problem solve, work independently and with team members
Courteous, professional, and respectful attitude
Flexibility to handle any non-standard situations that may arise
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
Preferred
Some college is preferred
At least two years' experience in adjudicating/examining claims for a Commercial Insurance Company, Tricare, MAC, or organizations performing similar functions, preferred
At least five years' experience of provider professional billing, coding, and documentation practices in an outpatient setting, DME, home health, infusion, or hospice to Commercial Insurance Companies, Medicare, Medicaid, Tricare, or organizations performing similar functions, highly desirable
Familiarity in quality assurance for internal compliance of billing practices
Clerical experience dealing with any aspect of: ICD-10, CPT-4 or HCPCS coding
Experience using Microsoft Excel and other Microsoft Office applications
Benefits
Medical
Dental
Vision
HSA/FSA options
Life insurance coverage
401(k) savings plans
Family/parental leave
Paid holidays
Paid time off annually
Company
Performant Healthcare, Inc.
Billions of dollars are lost each year to waste, improper payments and unpaid debts.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$25MKey Investors
Wells Fargo
2023-11-07Post Ipo Debt· $25M
2012-08-10IPO
Leadership Team
Simeon Kohl
Chief Executive Officer
Rohit R.
Chief Financial Officer
Recent News
2024-11-12
2024-11-06
Company data provided by crunchbase