Healthcare Billing Recovery Case Specialist I (SCA)

**Who We Are** Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence. **About the Opportunity** As a **Healthcare Billing Recovery Outreach Specialist I (SCA)**, you are assigned health insurance carrier, auto/home/worker’s comp insurance carrier, or legal representatives (“stakeholders”) of Group Healthcare (GHP) and/or Non-Group Healthcare Provider (NGHP) cases under the CMS Medicare Secondary Recovery Program. The Outreach team works with the Medicare Secondary Payer (“MSP”) Debtor stakeholder community for Performant’s assigned cases to address their high priority questions and concerns regarding MSP case demands and related MSP correspondence. In addition, the Outreach team provides education and feedback to this MSP stakeholder community to help them understand the full scope of Performant’s responsibilities and operating processes, as well as the stakeholder’s corresponding responsibilities to ensure that MSP debts are paid timely and accurately. **What you’ll do** - Leverage your knowledge and expertise in TPL/COB/MSP to review case documentation and any previous case work and activities completed by caseworkers to validate liability, responses to defenses regarding payment liability, status the account and letter correspondence, etc. in preparation to respond to and/or reach out to stakeholders. - Answer questions (on the phone and/or in writing as appropriate) and/or provide information and education to the stakeholder(s) that will bring to successful payment or other appropriate account action. - Responsible for monthly Outreach calls for assigned stakeholders which includes creating agendas, taking meeting minutes and responding to all phone calls or email inquiries. - Initiate correct action with applicable party and documentation based upon payment option, actions required if review of case and/or new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay. - Updates client and/or company systems with clear and accurate information such as involved party(ies) contacting the CRC, notes from contact dialog, as well as account status updates as applicable. - Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures. - Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims. - Arrives to work on-time, works assigned schedule, and maintains regular good attendance. - Follows and complies with company, departmental and client program policies, processes and procedures. - Responsible for utilizing resources to ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations. - Successfully completes, retains, applies and adheres to content in required training as assigned - Consistently achieve or exceed established metrics and goals assigned, including but not limited to, production and quality. - Completes required processes to obtain client required clearances as well as company regular background and/or drug screening; and, successfully passes and/or obtains and maintains clearances statuses as a condition of employment. (note: client/government clearance requirements are not determined or decisioned by Performant.) - Demonstrates Performant core values in performance of job duties and all interactions. - Cor…