The Outreach team works with the Medicare Secondary Payer (“MSP”) Debtor stakeholder community for Performant’s assigned cases to address their high priority questions and concerns regarding MSP case demands and related MSP correspondence. In addition, the Outreach team provides education and feedback to this MSP stakeholder community to help them understand the full scope of Performant’s responsibilities and operating processes, as well as the stakeholder’s corresponding responsibilities to ensure that MSP debts are paid timely and accurately.

As a Healthcare Billing Recovery Outreach Specialist you are assigned health insurance carrier, auto/home/worker’s comp insurance carrier, or legal representatives (“stakeholders”) of Group Healthcare (GHP) and/or Non-Group Healthcare Provider (NGHP) cases under the CMS Medicare Secondary Payer recovery program with responsibilities to include, but not limited to:

Leverage your knowledge and expertise in TPL/COB/MSP to review case documentation and any previous case work and activities completed by caseworkers to validate liability, responses to defenses regarding payment liability, status the account and letter correspondence, etc. in preparation to respond to and/or reach out to stakeholders.

Answer questions (on the phone and/or in writing as appropriate) and/or provide information and education to the stakeholder(s) that will bring to successful payment or other appropriate account action.

Responsible for monthly Outreach calls for assigned stakeholders which includes creating agendas, taking meeting minutes and responding to all phone calls or email inquiries.

Initiate correct action with applicable party and documentation based upon payment option, actions required if review of case and/or new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.

Updates client and/or company systems with clear and accurate information such as involved party(ies) contacting the CRC, notes from contact dialog, as well as account status updates as applicable.

Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.

Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.

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.

May be required to work some Performant holidays due to client requirement.

Other Duties

Performs other duties as assigned.

Required Skills and Knowledge:

**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 location. Basic office equipment required to perform remote work is provided by the company.

To perform this job successfully, an individual must be able to perform each essential function satisfactorily. Below are representative of the knowledge, skills, and abilities required:

Knowledge and experience with medical claim billing procedures, medical terminology and medical coding (including information in forms UB04 and CMS 1500), preferably in a role generating, auditing, recovery and/or researching the same including Medicare and Medicaid claims.

Experience with Coordination of Benefits (COB), Third Party Liability (TPL), Medicare Secondary Payer (MSP) with proven expertise in gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues, including Medicare and Medicaid claims.

Demonstrated ability to successfully complete high-quality MSP GHP and NGHP casework in accordance with company, client (CMS) and regulatory requirements.

Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues;

Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude and approach.

Demonstrated professional verbal and written communication skills to communicate professionally and effectively with internal audiences at all levels as well as externally with providers, carriers, beneficiaries and other audiences regarding claims and billing 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.

Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.

Additional Requirements:

• Ability to obtain and maintain client requiredclearances as well as pass company regular background and/or drug screening.

• Completion of Teleworker Agreement upon hire, andadherence to the Agreement (and related policies and procedures) including, butnot limited to: able to navigate computer and phone systems as a user to workremote independently using on-line resources, must have high-speed internetconnectivity, appropriate workspace able to be compliant with HIPAA, safety& ergonomics, confidentiality, and dedicated work focus withoutdistractions during work hours.

Physical Requirements:

Available for hire Teleworking in the following arealocations: Florida (Sunrise/BrowardCounty) & Texas (San Antonio).

**NOTE: Must be able to meet requirements for andperform work assignments in accordance with Company policies and expectationson a home remote basis (and must meet Performant remote-worker requirements)until at which time staff may be notified and required to work from aPerformant office location on an ad-hoc or periodic basis.

Basic office equipment required to perform remote workis provided by the company.

• Job is performed in a standard busy office environmentwith moderate noise level (or may be home-office setting subject to Companyapproval and Teleworker Agreement), sits at a desk during scheduled shift, usesoffice phone or headset provided by the Company for calls, making outboundcalls and answering inbound return calls using an office phone system; views acomputer monitor, types on a keyboard and uses a mouse.

• Reads and comprehends information in electronic(computer) or paper form (written/printed).

• Sit/stand 8 or more hours per day; has the option tostand as needed while on calls; reach as needed to use office equipment.

• Consistently viewing a computer screen and typesfrequently, but not constantly, using a keyboard to update accounts.

• Consistently communicates on the phone as requiredprimarily within the department and company and may include client contacts orother third-party depending on assignment with account holders, may dialmanually when need or use dialer system; headset is also provided.

• Occasionally lift/carry/push/pull up to 10lbs.

Education and Experience:

High School diploma or GED required

Minimum 12 months of experience working , demonstrating depth of knowledge and capability required for the position.

Must have experience with Coordination of Benefits and Medicare Secondary Payer involving both Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties. Internal candidates must have demonstrated successful QA results and standing.

Minimum 3 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills.

Other Requirements:

Other Requirements:

Performant is a Government contractor and subject tocompliance with client contractual and regulatory requirements, including butnot limited to, Drug Free Workplace, background requirements, and clearances(as applicable).

• Must submit to and pass pre-hire background check, aswell as additional checks throughout employment.

• Must be able to pass a criminal background check; mustnot have any felony convictions or specific misdemeanors, nor on state/federaldebarment or exclusion lists.

• Must submit to and pass drug screen pre-employment (andthroughout employment).

• Performant is a government contractor. Certain clientassignments for this position requires submission to and successful outcome ofadditional background and/or clearances throughout employment with the Company.

Employment VISA Sponsorship is not available for thisposition

Job Profile is subject to change at any time.

EEO

Performant Financial Corporation is an Equal OpportunityEmployer.

Performant Financial Corporation is committed tocreating a diverse environment and is proud to be an equal opportunityemployer. All qualified applicants will receive consideration for employmentwithout regard to race, color, national origin, ancestry, age, religion,gender, gender identity, sexual orientation, pregnancy, age, physical or mentaldisability, genetic characteristics, medical condition, marital status,citizenship status, military service status, political belief status, or anyother consideration made unlawful by law.

NO AGENCY SUBMISSIONS WITHOUT PERFORMANT AUTHORIZEDAGENCY AGREEMENT AND APPROVED PERFORMANT JOB ORDER5.