Job details
Job type full-time
Full job description
The healthcare data business intelligence analyst`s focus is to create and maintain new audit concepts and algorithms for performant’s client contract through concept research, data analysis, preparation of rule documents and code lists, and updating existing edits as neededThis position also creates complex and data mining pre-payment edits and algorithms.
Essential responsibilities:
Identifying and developing new concepts to recoup inappropriate medicare payment.
Identifying concepts for potential recoupment through automated and complex audits by analyzing health services utilization data (e.g., medicare claims) and researching sources of new concepts
Researching concepts approved for development
Applying appropriate medicare, medicaid and other regulatory policy and rules
Participating in development of new concepts
Creating new concept proposal forms
Writing good cause and rationale documents
Identifying pertinent regulatory back-up and references
Developing selection criteria/edit parameters, including refining probes, analyzing probe results
Selecting claim examples to prove the concept
Assisting in the creation of medical review guidelines, as needed
Mentoring and coordinating subcontractor
Work with data mining auditors and data engineering teams to develop and refine probes
Performing qa functions of new concepts
Working in partnership with department co-workers and across departments
Keeping abreast of medical practice, changes in technology, and regulatory concepts that may affect the client contract
Lead the ideation efforts within performant teams
Note - all employees and contractors for performant financial may and/or will have access to sensitive, proprietary, confidential and/or public dataAs 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 timesViolations to performant’s policy related to the confidentiality or integrity of data may be subject to disciplinary actions up to and including termination.
Required skills and knowledge:
Expertise in icd-9-cm, icd-10-cm/pcs, cpt-4, and hcpcs coding;
Knowledge of the national coding standards, particularly payment rules
Knowledge of commercial claims processing systems
Knowledge of the medicare program, particularly medical policy and payment
Experience analyzing and manipulating health care data.
Experience with diagnostic grouper tools and techniques (drg, etg, meg) a plus.
Data manipulation skills using database and spreadsheet applications.
Working knowledge of database applications, including extraction and querying skills.
Ability to analyze raw data and disseminate results, with ability to think logically, and process sequentially with a high level of detailed accuracy and coach junior analysts to perform same.
Excellent written and verbal communication skills, with the ability to multitask and prioritize projects for self and subordinate team members, to meet scheduled deadlines.
Completion of teleworker agreement upon hire, and adherence to the agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with hipaa, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.
Physical requirements
**note: must be able to meet requirements for and perform work assignments in accordance with company policies and expectations on a home remote basis (and must meet performant remote-worker requirements) until at which time staff will be notified and required to work from a performant office locationBasic office equipment required to perform remote work is provided by the company.
Performs duties in a busy standard office environment with moderate noise level(or home-based telework environment in accordance with company policies and procedures).
Sits or stands at a desk, reaching as needed to use office equipment.
Makes and returns calls using an office phone system or company issued cellular phone.
Views a computer monitor, types on a keyboard, and uses a mouse.
Reads and comprehends information in electronic (computer) or paper form (written/printed).
Types frequently, but not constantly, using a keyboard and mouse.
Occasionally lifts/carries/pushes/pulls up to 10 pounds.
Travel as required to meet business needs.
Education and experience:
10 plus years of healthcare provider reimbursement experience specific to managed care contracting, medical billing, claims auditing, claims analysis and/or actuarial analysis.
Ba/bs degree in nursing, cs, finance or accounting preferred
Other requirements
Must submit to and pass pre-hire background check, as well as additional checks throughout employment
Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors, nor on state/federal debarment or exclusion lists.
Must submit to and pass drug screen pre-employment (and throughout employment).
Performant is a government contractorCertain client assignments for this position requires submission to and successful outcome of additional background and/or clearances throughout employment with the company.
Visa sponsorship is not available.
Job profile is subject to change at any time.
Eeo
Performant financial corporation is an equal opportunity employer.
Performant financial corporation is committed to creating a diverse environment and is proud to be an equal opportunity employerAll 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.
No agency submissions without performant authorized agency agreement and approved performant job order
