Healthcare Eligibility Analyst II

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:

The Healthcare Eligibility Analyst II plays an important role in the success of the Eligibility services we provide our clients by applying strong knowledge and skills to review and analyze large volumes of client records, investigate coverage to determine primacy, and initiate coverage updates that maximize revenue for our clients. The Analyst demonstrates strength of knowledge and skills by adapting quickly to add value to various client programs, consistently exceed productivity and quality results, as well as identify and resolve non-standard eligibility updates and primacy issues that drive revenue.  The level II Analyst may contribute to continuous improvement projects or new client programs, as needed.

Key Responsibilities:

• 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 and successfully navigate to achieve results consistently with scope of assignment including multiple carriers, TPL, and other characteristics.  Demonstrates ability to apply skills and meet expectations across multiple client programs.

• Communicate effectively with carriers to update validated eligibility records and primacy; answer questions and/or provide information that will bring to successful payment or other appropriate account action.

• Contact Healthcare Insurance carriers, employers, and/or providers regarding eligibility discrepancies. 

• Educate Healthcare Insurance carriers, employers, and/or providers on the Coordination of Benefits Rules, and demonstrates ability to respond to complex questions.

• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).

• Effectively works assigned inventories to consistently exceed productivity metrics assigned by management, while also performing other duties of the senior analyst role that support the broader group.

• Leverage knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g., eligibility research and claims appeals) demonstrating ability to consistently resolve the most complex eligibility discrepancies and questions.

• Initiate applicable action and documentation based upon insurance carriers selected. 

• Update company systems with clear and accurate information such as point of contact, updated demographic information, notes from contact from outbound and inbound calls and/or attempts, as well as account status updates as applicable.

• May contribute to ideas and approaches to further the enhancement of our products and services, workflows, documentation, and training. 

• May partner with Sr. Analysts or management to contribute to various projects, continuous improvement efforts, training materials, or development for new client programs.

• Serves as a positive example and upon request, able to assist representatives and junior analyst team members to answer questions and assist in knowledge/skill enhancement.

• May contribute to quality review activity upon management request.  

• Follows and complies with company, departmental and client program policies, processes, and procedures.

• Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.

• Successfully completes, retains, applies, and adheres to content in required training as assigned.

• Consistently achieve or exceed established metrics and goals assigned, including but not limited to, production, quality, and completion of assigned projects with high quality and timely results.

• Correct areas of deficiency and oversight received from quality reviews and/or management.

• Performs other duties as assigned.
   

Knowledge, Skills, and Abilities Needed:

• Strong knowledge and material on-point experience with healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovering and/or researching the same.

• Demonstrated expertise in Eligibility and all related facets relevant to Commercial Third-Party Liability (TPL) aligned with Performant’s client programs that results in ability to identify and resolve non-standard and complex primacy/eligibility errors that results in revenue restoration for our clients. 

• Proven strength in researching uncovered eligibility details and resolving data errors leveraging strong analytical skills, ability to interpret and apply a wide variety of policies and information that contributes to identifying what information sources to research and approach to asking questions to seek applicable information from diverse sources, and unwavering professional persistence in obtaining the full scope of data and analyzing to routinely resolve non-standard and often complex primacy issues.

• Demonstrates high degree of critical thinking and analytical accuracy required to be successful in the role.

• Ability to communicate professionally and effectively with providers, carriers, beneficiaries, and other audiences regarding eligibility and/or Coordination of Benefits (COB). 

• Proven ability to gather and interpret Explanation of Benefits (EOB) and answer questions and resolve standard as well as complex issues with payments.

• Protect patients’ privacy, understands, and adheres to HIPAA standards and regulations.

• Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude; develops positive rapport with clients. 

• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.

• Strong skills using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.

• Intermediate to advanced Microsoft Excel skills.

• Applies knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.) and can provide instructional support to others.  

• Ability to follow policy, procedures, and regulations in the workplace, and demonstrates ability to lead by example and support development of junior team members.

• Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment; effectively serve as subject matter expert, lead by example, and be a lead contributor to the team’s overall results and progress. 

• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes; able to support team adaptation to change.

 Required and Preferred Qualifications:

• High School diploma or GED required; some college preferred.

• Minimum four years of directly relevant progressive experience (billing reclamation, recovery, eligibility, etc.), including Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer, demonstrating depth and breadth of knowledge and capability required for the position.

• Experience must demonstrate consistent ability to independently deliver high volume quality results over a sustained period in a similar function, and large volume portfolio of diverse scope.

• Demonstrated experience gathering, researching, and documenting data and requirements for projects and/or complex problem solving.

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.

THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED