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:

The focus of theHealthcare Provider Contract and Pricing Analystis to create and maintain fee schedules for Performant claims repricing, and contract audit departments. This includes quality assurance of fee schedule loads and creation of queries to identify improper payments.

Key Responsibilities:

*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 overpayment files

*Respond to internal and external questions regarding data results and pricing calculations

*Support concept development by researching concepts and applying appropriate Medicare, Medicaid and other regulatory policy and rules

*Select claim examples to prove and quantify the concept value

*Keeps abreast of medical practice, changes in technology, and regulatory concepts, or changes in reimbursement that may affect the Client contracts

*Participate in the development or analysis of new concepts and related data

*Other duties as assigned to meet business needs

Knowledge, Skills and Abilities Needed:

*Expertise in ICD-10-CM/PCS, CPT-4, and HCPCS coding;

*Experience with diagnostic grouper tools such as DRG, APR-DRG, EAPG, APC preferred

*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

*Ability to work independently and meet deadlines

*Data manipulation skills using database and spreadsheet applications

*Working knowledge of database applications such as SQL and/or VBA, including extraction and querying skills

*Expertise using Microsoft Excel and the ability to quickly develop expertise in new systems and applications.

*Ability to analyze raw data and disseminate results. Use of logical and critical thinking skills and exceptional problem-solving skills to identify solutions to complex scenarios

*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 other team members, to meet scheduled deadlines.

Required and Preferred Qualifications:

*BA/BS degree in relevant field, or equivalent combination of relevant education and experience.

*5+ years of healthcare provider reimbursement experience specific to managed care contracting, medical billing, claims auditing, claims analysis and/or actuarial analysis relevant to the position.

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