Healthcare Services Concept Specialist (Certified Outpatient Coding SME)

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!

he Healthcare Services Concept Specialist provides support to assigned Segment Specialists by maintaining current audit concepts as well as provide support for the development process of new audit concepts.

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 coordinate) as necessary for changes to existing concepts. -May contribute to development of training materials and tools for new concepts. Conduct research, identify impact on existing concepts, and document accordingly (may support Segment specialists with research for new concepts). Interpret and apply policy in existing concept review/updates or ask may be requested in support of Segment Specialists for new concepts. Support activities required to “package” concepts, including, but not limited to, pulling together necessary documents, and supporting data in appropriate order and locations, coordinating activities and documenting process steps, proofing documents, and tracking/reporting status. Ensure audit concepts are well formulated for Offerings (Data Mining vs Complex Audit vs FWA Leads & CMS vs Medicaid vs Commercial) Manage, progress, and track multiple tasks within multiple workflows for audit concept maintenance with high degree of accuracy and quality providing status reports and deliver results on-time. May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims, as necessary. Stay abreast of industry policy. Works very closely with other team members to ensure on time project deliveries, cross train, and knowledge transfer, and maintain required quality and productivity standards. Performs other duties as assigned and required to meet business needs.