Supervisor, Healthcare Billing Recovery Operations

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 looking for a highly-skilled, talented Healthcare Billing Recovery Operations Supervisor that drives results and leads by example leveraging expertise in Medical Billing Recovery, knowledge of Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) and procedural challenges regulations; experience generating or auditing medical bills; proven ability to interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; and communicate effectively with liable parties to recapture payments. Ability to train and guide Billing Recovery Case Specialists, handle escalated calls and cases; and support management with compliance, quality, program operation functions such as Insurer/Plan outreach or case inventory assignments, and continuous improvement efforts. Also performs supervisory functions, coaches employees for development, provides constructive feedback and disciplinary actions in conjunction with the applicable operational manager.

Key Responsibilities

As the Healthcare Billing Recovery Operations Supervisor, you will be responsible for Specialists (caseworkers) performing billing and recovery services to/for Group Health Plans, Non-Group Health Plans, and other related, authorized, and liable parties.

• Ensure staffing and training of case specialists for assigned business.

• Contribute to development and continuous improvement of operational tools, processes and procedures.

• Ensure assigned team consistently achieves established metrics and goals assigned, quality and compliance requirements.

• Leads by example and demonstrates Performant core values in performance of job duties and all interactions.

• Provides feedback, coaching and additional training to assigned team to correct areas of deficiency and oversight received from quality reviews and/or management, as well as performance feedback and skills development to increase capability and effectiveness of specialists.

• Oversee work activities and provide guidance for case and call escalation to specialists including, but not limited to:

• Review account claim and other documentation to verify payment liability for claims paid in error.

• Make outbound calls to contact liable parties regarding payment of claims; answer questions and educate liable parties on their obligation to pay.

• Effectively follow scripts, guidelines and other tools provided to have professional conversations with liable party contacts.

• 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 initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action.

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

• Update company systems with clear and accurate information

• Initiates activity based upon arrangement with liable parties; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.

• Escalates accounts for Nurse Case Worker review as appropriate for complex claims.

• 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.

• Ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.

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

• Perform other incidental and related duties as assigned to meet business needs.

Knowledge, Skills and Abilities Needed

• Demonstrated ability to lead and drive operational results in similar healthcare billing recovery or insurance claim review function. Leverages operational reports and data to evaluate team results and identify areas for improvement.

• Develops approaches and initiates action to improve and grow employee skills and team results.

• Demonstrated ability to inspire and lead a team of operational staff; knowledge of best practices to successfully hire, train, coach, motivate, develop, manage performance, and hold accountability of team members.

• Knowledge and experience with medical claim billing procedures, medical terminology, and medical coding, preferably in a role generating, auditing, recovery and/or researching the same involving Worker's Compensation, Auto Liability, and other non-group health plan primary payer liabilities.

• Experience with Coordination of Benefits and Medicare Secondary Payer involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties.

• Proven expertise in gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues, including Medicare and Medicaid claims.

• Ability to communicate professionally and effectively with management, staff, client and vendor representatives, providers, carriers, beneficiaries and other audiences regarding claims and billing payment.

• Protects 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 and servant leadership attitude.

• Ability to share knowledge and educate staff and third parties on healthcare billing and claims related terminology, procedures, and related information.

• Self-motivated and thrives in a fast-paced office environment 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, etc.).

• Ability to follow, teach, and support improvement of process, procedures, and workflow.

• Ability to effectively perform deliver results, and work cooperatively with others to promote a positive team environment.

• Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs.

• Ability to consistently perform job responsibilities.

• Possess a personality type that is ethical, friendly, hard-working, and proactive.

Required and Preferred Qualifications

• Minimum 2 years of experience as a supervisor, or lead with supervisory responsibilities, for similar function.

• Minimum 5 years of experience in medical billing experience demonstrating depth of knowledge and capability required for the position.

• Minimum 3 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills preferably in a healthcare or related industry.

• High School diploma or GED required.

• Some college in medical terminology, billing, coding, or Medical Billing/Coding certification preferred.

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