Leverage knowledge and expertise in COB/TPL/MSP to gather and review documentation and eligibility information, investigate the file to determine proper order of benefits when multiple forms of coverage are available, and resolve primacy issues. Demonstrate ability to routinely identify and solve non standard and often complex data or record discrepancies and/or issues an

Performs analysis as required to support product development of both systems and components. Able to work independently on significant project components with minimal supervision and direction. Conducts analysis substantiating designs and iterates with system, project, and design engineering staff to optimize system and component designs Recommends technical decisions on

ly and accurately conduct coding reviews on medical records for assigned client audit contract in accordance with the statement of work while meeting compliance, productivity, and quality expectations. Conduct review of flagged claims and Fraud Waste & Abuse (FWA) referrals involving suspected upcoding, unbundling, anomalous coding, intentional miscoding, etc. Timely revie

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

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

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

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

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

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