Perform duties such as review and process various types of transactions, conduct data validation, data entry, and/or other process type functions Responsible for creation of daily, weekly, monthly, quarterly and annual reports for internal and external distribution. Track various regular file transmissions to ensure transactions are completed regularly, report files with

Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. Document all findings referencing the appropriate policies and rules. Generate letters articulating audit findings. Supporting your findings during the appeals process if requested. Working collabor

Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly). Collaborates with and leverages Segment Specialist expertise to ensure on point results. Ensure training material updates (may develop or coo

Responsible and leads reviews, ensures updates of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly). Ensure training material updates (may develop or coordinate) as necessary for changes to existing concepts. Contributes to developme

Lead by example through achieving excellent performance results, as well as compliance, attendance and behavior. Provides answers and handles escalation from team members Assist management in developing tools and/or communicating changes in requirements, systems, processes and procedures, as well as supports transition and adaptation by the team in a positive and effectiv

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

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

Review account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error. Leverage your knowledge and expertise in medical billing/COB/MSP to review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and

Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. Document all findings referencing the appropriate policies and rules. Generate letters articulating audit findings. Supporting your findings during the appeals process if requested. Working collabor

Interpret provider contract payment information for use by the complex and automated teams Develop logic for queries to identify inappropriate payments Analyze data results to ensure accuracy of contract interpretation and system loads Create and process system files, and needed workflows using available tools, specific layouts, conditions, and instructions to create over

Essential Duties Work closely with the operations teams and data team to ensure inventory is accurately and efficiently distributed/assigned and transferred across teams based upon applicable inventory type workflow and requirements. Conduct auditing of operations team activities on inventory to validate compliance with internal requirements, client contracts, regulatory

Work closely with the operations teams and data team to ensure inventory is accurately and efficiently distributed/assigned and transferred across teams based upon applicable inventory type workflow and requirements. Conduct auditing of operations team activities on inventory to validate compliance with internal requirements, client contracts, regulatory requirements, and

Review eligibility and other documentation to verify current payer order of benefits. Leverage your knowledge and expertise in COB/TPL to review eligibility, investigate the policy coverage to determine proper order of benefits and answer questions and/or provide information that will bring to successful payment or other appropriate account action. Ability to identify tre

Maintain a current knowledge of all contract requirements and objectives. Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors. Take inbound calls from providers to answer questions and resolve complex issues. Make outbound calls to healthcare providers as a courtesy to confirm if letters requesting records for re

Responsible for overseeing all financial functions for Performant and its subsidiaries, including all internal and external financial reporting. Works with CFO to establish responsibilities and procedures for attaining financial objectives. Approach daily work with an FP&A mindset, and work on deals of all types M&A, Vendors, Lenders, and Investors (in partnership with In