Medical Review Training Specialist (Clinical Nursing)

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!

The Medical Review Training Specialist (Clinical Nursing) partners with applicable operational business leaders, including functions such as compliance, appeals, and quality, and is responsible for the development, delivery, and continuous improvement of operational training program and tools for the line of business that contributes to increasing staff capability and its overall success. This position requires strong subject matter expertise, experience developing and delivering training content via a variety of methods and tools effective for remote workforce, excellent interpersonal and communication skills, and demonstrated ability to have meaningful impact on operational workforce capability through training programs and tools.

Employ a variety of methods to maintain current in-depth knowledge, requirements, and subject matter expertise for business segment (legal, regulatory, compliance, and client requirements) in a dynamic environment. Develop structured training program and material for policies & procedures and comprehensive review guidelines for audit, operations support, and other audit-related staff, with a specific emphasis on clinical nurse review. Maintaining the calendar of assigned training and ensuring that training is scheduled and delivered based upon internally developed timelines, legal, and contractual requirements, as applicable. Plan, coordinate, deliver, track, monitor, and report new hire training, as well as ongoing training as required for periodic refreshers, performance improvement, new or modified operating procedures, workflows, tools, requirements, etc. Employ a variety of methods to gather information and input to assess training gaps and programs effectiveness such as 360-degree feedback (from trainees, management, and applicable stakeholders), operational performance and QA results, appeals and other metrics at individual and group level, as well as from audit performance, QA results, Appeal metrics and other inputs. Provide instruction and direction to employees on proper usage of on-line training tools, and provides follow-up to ensure staff completion of required assigned training in a timely manner, leveraging support from employee’s management and/or HR if required. Apply outcomes of program assessment and needs inputs toward continuous improvement and further development of training program scope, courses, materials, and tools. Utilize effective adult learning training pedagogy to maximize successful knowledge transfer and skill building, as well as tools and methods for efficiency in training records management effectively in remote/virtual classroom, as well as in-office training. Conduct effective training 1:1 and various group size settings. Serve as a subject matter expert regarding official clinical guidelines, audit system functionality and audit workflows and files. Knowledge of payer reimbursement methodologies is a plus. Provide training on Audit guidelines, to ensure compliance with client requirements and in conformance with proper clinical nursing practices. Deliver concept-based training which may include reviewing operative reports and other documentation to properly code services using current CPT, HCPCS and ICD 10 CM/PCS codes. Proactively monitor changes to coding/clinical methodologies, official guidelines, regulatory standards, and update training material for delivery to auditors using relevant training methods. Support Medical Review management in documenting workflows and process improvement plans as needed. Provide consultative input to the development of business requirements for audit platform and reporting enhancements to prepare for User Acceptance testing and development of relevant training materials; deliver training on new client implementation, new audit programs, new audit products and/or new audit concepts. Conduct User Acceptance Testing on new workflow platform and/or reporting enhancements, ensuring correct functionality, documenting all changes and incorporating changes into training materials and training plans as required. Leads by example. Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements). Basic office equipment required to perform remote work is provided by the company. Other duties as required and assigned by management to meet overall business needs.