Healthcare Payer Relations Outreach Specialist

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 Healthcare Payer Relations Outreach Specialist supports Performant’s Healthcare team by initiating outreach into the healthcare community to establish and maintain relationships with stakeholders relevant to accomplishing Performant’s coordination of benefits and payment integrity business objectives. This position also completes and maintains enrollment and credentialing with various business partners, ensures successful claims submissions, and timely EDI transaction responses.

Essential Duties:

• Under general supervision, identifies, prioritizes, and leads outreach efforts for healthcare community stakeholders to facilitate eligibility data sharing and setup for electronic claims processing.
• Facilitates positive, collaborative relationships with healthcare community stakeholders and supports leadership with ad hoc scenarios involving stakeholder relationship management, and/or operational, or technical issues.
• Creates and maintains appropriate contracting vehicles for eligibility data sharing, claims processing, and other situations needed to accomplish Performant’s business objectives.
• Understands and can apply legal changes, guidelines, and other information that could impact Performant’s Healthcare business.
• Understands and can apply state and Federal laws and regulations that impact Performant’s eligibility and claiming integrity products and services.
• Completes payer (health plan) and PBM enrollment and/or credentialing forms to ensure accurate submission and acceptance of claim submissions.
• Completes continuous follow up on enrollments in process (telephone calls, emails, portals) and maintains all enrollment records and documentation.
• Drafts and refines policies, procedures, and other business collateral.
• Successfully completes, retains, applies, and adheres to content in required training as assigned.
• Demonstrates Performant core values in performance of job duties and all interactions.

Required Skills and Knowledge:

• Strong working knowledge of healthcare coordination of benefits and how legal, compliance, and regulatory requirements and guidelines may affect recovery and eligibility management.
• Experience with Medicaid / Medicare / Other TPL business models and products.
• Experience working with payer enrollment related processes and procedures.
• Strong written and verbal communication skills; demonstrates effective professional communication and presentation skills with internal and external audiences.
• Exceptional relationship management and interpersonal skills with the ability to produce results and maintain a positive attitude in fast paced, dynamic environment.
• General understanding of EDI X12 Transactions, including, but not limited to 270/271, 276/277, 837, 835.
• General understanding of payer enrollment processes and procedures.
• Strong analytical ability, and keen attention to detail.
• Highly skilled in project management and documentation.
• Self-motivated with the ability to manage multiple, and sometimes conflicting, priorities and meet deadlines.
• Proficient in MS Word, and Excel

Experience and Education:

• Bachelor’s degree in relevant field of study (or equivalent combination of education and experience).
• Paralegal certification a plus.
• 5+ years relevant healthcare experience (direct experience with eligibility, claiming, and/or revenue cycle preferred).
• 3+ years relevant experience working payer enrollment and/or payer relations.
• Demonstrated progressive experience working with healthcare stakeholders and/or regulatory entities.
• Demonstrated experience with project management and documentation.

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