HCS Operations Inventory & Quality Analyst – Eligibility

Job not on LinkedIn

🕒 June 30

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Performant Healthcare, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Performant Healthcare, Inc. is a U. S. -based, technology-enabled payment integrity and recovery company that helps health plans and government payers identify improper payments, recoup funds, and reduce waste. Performant combines data analytics, audit expertise, and recovery/collections infrastructure to deliver services including inpatient and outpatient audits, post-acute/home care audits, third-party liability (TPL) identification, Medicare Secondary Payer (MSP) outreach, lockbox and OCR document processing, and end-to-end recovery management. The company emphasizes scalable, customizable solutions (Audit Advantage, Data Mining Advantage, MSP Advantage, TPL Advantage, Recovery Advantage) to control costs and improve payment accuracy for managed care organizations and government agencies, backed by more than 40 years of recovery experience.

📋 Description

• 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 industry quality standards. • Facilitate communications and collaborate to convey/clarify requirements for inventory data flow based upon client/type/source serving as a liaison between the operations and eligibility & analytics data team. • Utilize SQL queries (and develop queries as may be needed) and leverage subject matter knowledge, independent judgement, and analytical skills to: Test data transfer/flow results. Perform audit activity. Create and maintain regular internal/external activity and metrics reporting; and Other support for operations workflow and activity. • Mentors operations team and data team on paper and electronic claims processes Creates and maintains internal and external reporting as needed. • Contribute to development and continuous improvement of operational tools, processes and procedures for quality and inventory. • Provides Supervisors/Management with staff production quality results, as well as any insights for feedback/coaching/training opportunities based upon themes/trends identified to correct areas of quality deficiency and improve overall results. May support management with developing or delivering training and tools for skills development to increase capability and effectiveness of analysts. • Operates under minimal supervision to deliver results aligned with business goals, given guidance in the form of high-level objectives. • 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. • Correct areas of deficiency and/or areas of opportunity for improvement received from management.

🎯 Requirements

• Bachelor’s degree in relevant field, or equivalent combination of education and experience • At least three (3) years of directly related progressive experience (claims, billing, eligibility, Medicaid/Medicare, etc.), including Coordination of Benefits and Third-Party Liability, demonstrating depth and breadth of knowledge and capability required for the position • Minimum two (2) years relevant experience demonstrating ability to work with large volumes of healthcare eligibility or client data, including data reporting, modeling, and analysis • Minimum 1 year of relevant experience in role(s) with responsibility for applying subject matter expertise to operations workflow, contributing to the set-up of new clients or programs, projects, quality/auditing, direct or indirect staff oversight or training, etc. and contributing to the development of infrastructure and continuous improvement for department output

🏖️ Benefits

• medical • dental • vision • HSA/FSA options • life insurance coverage • 401(k) savings plans • family/parental leave • paid holidays • paid time off annually