Medical Review Specialist - Remote
Performant Financial Corporation / DCS Healthcare - Chicago, IL

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Medical Review Specialist ** This is a remote position available throughout the state of Illinois**Performant Financial Corporation, parent to a number of companies, is a leading specialized technology and services company delivering high value-added, technology based, knowledge process outsourcing solutions primarily to entities within Government, Healthcare Services verticals. Performant's services generally comprise core aspects of an organization's operations and thus are "mission critical' in nature.Performant Financial Corporation is headquartered in Livermore, California, and employs 960+ people in four offices. We offer a competitive total compensation package, including health benefits, paid time off, 401k and life insurance. Additionally we have EAP, supplemental insurance and a scholarship program. Answer customer service inquiries, assist in identifying vulnerabilities, and performing coding reviews. Additionally they will be knowledgeable of all contract goals, objectives and requirements. Conduct Coding reviews. Facilitate and process requests from and/or to the DCS Team Make necessary contacts and/or perform necessary research to validate provider contact information Contact healthcare providers on overpaid claims and maintain collection records and account status updates Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors. Establish good contact with providers to guarantee proper claim presentation and follow up Enter and update all contact and activity information into MARS where not automatically completed by the system, e.g., a telephone call is made, recorded, and attached to the case file in MARS, but the outcome must be extracted from the call and input into MARS Notify management of: all correspondence indicating displeasure with the RAC, in the overpayment identification, or in the recovery methods utilized, legal action government intervention Research and route internal/external communications to the appropriate person or department, including referrals received from Medicare contractors and documents, calls, and faxes sent to Medicare contractors by mistake Conduct critical due diligence follow-ups of unread media Answers questions from providers and resolves issues via phone and written correspondence Educating providers on their appeal rights Communicate with other staff/departments as necessary Report and validate debts ineligible for referral by category to management Maintain a current knowledge of all Medicare rules, regulations, policies and procedures Maintain current knowledge of all contract requirements and objectives Maintain HIPAA Certification Conduct simple coding reviews Perform miscellaneous duties as assigned in a highly professional manner
Minimum Qualifications: Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P Excellent verbal and written communication skills Skilled in data entry and knowledge of computers Courteous, professional, and respectful attitude Strong understanding of customer service policies and processes Basic understanding of accounts payable and receivable Possess knowledge of CMS rules and regulations Knowledgeable of the uses of ICD-9, HCPCS/CPT codes Proficient in the use of HCFA/UB forms Flexibility to handle any non-standard situations that may arise Must be able to multi task Experience: Previous Medical claims processing, and/or medical customer service 2+ years experience coding for an inpatient facility/SNF Facility Thorough working knowledge of CPT/HCPCs/ICD-9 coding