Healthcare Eligibility Analyst

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:

We are seeking a highly-skilled, talented Healthcare Eligibility Analyst with strong knowledge of healthcare eligibility, medical terminology, eligibility validation practices, Coordination of Benefits and Third Party Liability (COB/TPL), and Medicare Secondary Payer (MSP); proven ability to gather information, answer questions, and resolve primacy issues through coordination of benefits when multiple forms are of coverage are available; and communicate effectively with carriers to update validated eligibility records and primacy. 

As a Healthcare Eligibility Analyst, you will review assigned records, investigate coverage, and determine primacy to maximize revenue for our client’s recovery programs with responsibilities to include, but not limited to:

Key Responsibilities

• Review eligibility and other documentation to verify current payer order of benefits.
• Leverage your knowledge and expertise in COB/TPL/MSP to review documentation and eligibility, investigate the file to determine proper order of benefits and 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.
• Analyze and understand written communication from insurance companies including explanation of benefits (EOBs).
• Support internal groups or functions with gathering and interpretation of the eligibility work to development with knowledge base and understanding of key concepts and terminology in healthcare eligibility.
• Effectively follow and contribute to continuous improvement of scripts, guidelines and other tools provided to have professional conversations with Healthcare Insurance carriers, employers, and/or providers.
• Efficiently and diligently work through assigned inventories to meet productivity metrics assigned by management.
• Leverage your knowledge and expertise to research various scenarios that will bring to successful resolution and payment (e.g. eligibility research and claims appeals)
• 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.
• Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
• 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 and quality.
• Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (Note: client/government clearance requirements are not determined or decisioned by Performant.)
• Demonstrates Performant core values in performance of job duties and all interactions.
• Correct areas of deficiency and oversight received from quality reviews and/or management.
• Work overtime as may be required.
• Performs other duties as assigned.

Knowledge, Skills and Abilities Needed

• Knowledge and experience with healthcare, medical terminology, and medical coding, preferably in a role generating, auditing, recovery and/or researching the same.
• Experience with Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer
• Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve primacy issues.
• 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 issues with payment.
• Protected 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.
• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
• Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
• Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.).
• Ability to follow process, procedures, and regulations in the workplace.
• Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment.
• Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
• Ability to consistently perform job responsibilities.

Required and Preferred Qualifications

• Minimum 6 months of relevant experience, including Healthcare, demonstrating depth of knowledge and capability required for the position.
• Minimum 2 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills.
• High School diploma or GED

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