Healthcare Provider Contract and Pricing Manager

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 Manager, Healthcare Provider Contract and Pricing has responsibility for managing staff and creating an infrastructure to support Performant's claims repricing and contract audits ensuring the needs of the business are met for successful daily operations of healthcare audit and recovery.

Key Responsibilities to include:

• Oversee team functions including, but not limited to:

• Interpretation (and documentation of) provider contract payment information for use by the complex and automated teams

• Development of algorithms to identify inappropriate payments

• QA of fee schedule loads - Analysis of data results to ensure accuracy of contract interpretation and system loads

• Creation and processing of system files, and needed workflows using available tools, specific layouts, conditions, and instructions to create overpayment files

• Responds to internal and external questions regarding data results and pricing calculations

• Participate in the development or analysis of new/changing concepts and related data

• Concept research and application of appropriate Medicare, Medicaid and other regulatory policy and rules

• Conducting sample tests to prove and quantify the value of concepts

• Hires, trains, and develops staff; proactively manages team performance against objectives and deliverables to ensure high quality output meets business needs, and: resolves conflict in a tactful and effective manner.

• Develops and ensures training and support to new team members as well as all team members for any new or changing workflows or requirements

• Develop and maintain infrastructure tools and documentation as well as contribute to the development and/or improvement based upon changing requirements and/or new client requirements/contracts.

• Drives research, analysis and resolution of complex questions, issues, and needs that arise.

• Drives continuous improvement efforts and develops/delivers tools and training to increase knowledge, efficiency, and consistency of department output.

• .Applies strong communication and interpersonal skills to develop professional relationships and collaborates effectively with internal department leaders/staff, as well as clients and other external stakeholders and service providers.

• Maintains current knowledge of and compliance with company policies, processes and procedures, Medicare/Medicaid rules, regulations, policies and procedures, contract requirements, and HIPAA certification; and ensures team members do the same.

• Keeps abreast of medical practice, changes in technology, and regulatory concepts, or changes in reimbursement that may affect the Client contracts.

• Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours.

• Other Duties as assigned

Knowledge, Skills and Abilities Needed:

• Excellent verbal and written communication and interpersonal skills; ability to effectively communicate at all levels within the organization both internal and external.

• Strong project and operations management skills; inventory management, resource planning, developing, and leveraging reports; developing policies and procedures.

• Leverages strong analytical, critical thinking and problem-solving skills; Skill in analyzing information, identifying trends, and presenting solutions.

• Demonstrated ability to apply excellent judgement and decision-making skills.

• Demonstrated success building and lead high performing teams.

• Adaptable and thrives in a fast-paced dynamic environment with changing priorities.

• Possess broad and comprehensive understanding of applicable healthcare concepts, standards, tools, policies, and regulations relevant for medical claim repricing:

• Knowledge in ICD-10-CM/PCS, CPT-4, and HCPCS coding;

• Experience with diagnostic grouper tools such as MS DRG, APC, APR-DRG, EAPG, preferred

• Experience in interpreting provider contracts payment methodologies, preferred

• Knowledge of the national coding standards, particularly payment rules

• Knowledge of commercial claims processing systems

• Knowledge of Medicare/Medicaid programs, particularly payment rules

• Experience analyzing and manipulating health care data leveraging strong data manipulation skills. using database and spreadsheet applications.

• Strong computer skills; intermediate level experience with MS Office products including Outlook, Word, PowerPoint, intermediate to advanced Microsoft Excel, and the ability to quickly develop expertise in new systems and applications.

• Use of logical and critical thinking skills and exceptional problem-solving skills to identify solutions to complex scenarios.

Required and Preferred Qualifications:

• BA/BS in relevant field (e.g., Finance, Accounting, Healthcare Administration) or equivalent combination of relevant education and experience.

• 7+ years of relevant experience in healthcare provider reimbursement and/or health insurance payor experience in medical billing, claims auditing, claims analysis and/or actuarial analysis.

• Minimum of 3 years in supervisory/management that includes oversite for remote staff.

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