Healthcare Services Concept Specialist

3 weeks ago


Fort Lauderdale, Florida, United States Performant Full time
About Performant

At Performant, we're dedicated to helping our clients achieve their goals by providing innovative payment accuracy solutions. Our team of experts identifies improper payments and recoups or prevents losses due to errant billing practices. We're the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare.

About the Opportunity

We're seeking a skilled Healthcare Services Concept Specialist to provide support to our Segment Specialists. The successful candidate will maintain current audit concepts and contribute to the development of new concepts. Key responsibilities include reviewing and updating existing concepts, ensuring training material updates, conducting research, and interpreting policy.

Key Responsibilities
  • Review and update existing concepts based on periodic review cycles or client/regulatory changes.
  • Collaborate with Segment Specialists to ensure on-point results.
  • Develop and coordinate training material updates for changes to existing concepts.
  • Conduct research and identify impact on existing concepts.
  • Interpret and apply policy in existing concept review/updates.
  • Support activities required to package concepts, including pulling together necessary documents and tracking/reporting status.
  • Ensure audit concepts are well formulated for Offerings.
  • Manage multiple tasks within multiple workflows for audit concept maintenance.
  • Contribute to responses to provider/client representative inquiries as necessary.
  • Stay abreast of industry policy.
  • Work closely with team members to ensure on-time project deliveries and maintain quality standards.
Requirements
  • Demonstrated knowledge of Medicare and Commercial policy and claims process.
  • Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding.
  • Knowledge of national coding standards and payment rules.
  • Ability to understand and apply complex policies, procedures, regulations, and legal statutes.
  • Strong verbal communication and interpersonal skills.
  • Excellent written communication skills.
  • Good critical thinking, analytical, questioning, and listening skills.
  • Flexibility to handle non-standard situations and adapt to changing business needs.
  • Time management skills for managing multiple tasks simultaneously.
What We Offer

Performant offers a wide range of benefits to support a healthy work/life balance, including medical, dental, vision, disability coverage options, life insurance coverage, 401(k) savings plans, paid family/parental leave, 11 paid holidays per year, and sick time and vacation time off annually.
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