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!

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ABOUT THE OPPORTUNITY:

Hiring Range: $21.50/Hour

Member Advocates are the primary point of contact for health plan members. They are responsible for assisting with coordination and communication between patients and medical professionals (i.e. physicians/nurses/case managers/pharmacies) which may include lending assistance with benefit education, appointment scheduling, navigating referral/authorization processes, cost-management, community resource connections, and assisting with pharmacy benefits.

Key Responsibilities to include:

Make outbound calls to members who have indicated perceived gaps in care
Take inbound calls, answer questions regarding the program, document communication
Provide benefit education to members (explain copays, coinsurance, deductibles, in and out of network benefits, and formularies)
Schedule follow up times for additional care coordination management and/or community resource connections
Develop professional working relationships with colleagues, healthcare providers and other contractors
Conduct critical due diligence follow-ups if additional research or action is required to resolve a call the member’s concern/complaint
Enter and update all contact and activity information into system e.g., a telephone call is made, recorded, and attached to the case file in the system
Notify management of:
- displeasure or escalated concerns with the program
- legal action
- government intervention
- suggestions to improve or correct processes or documents
Communicate with other staff/departments as necessary
Maintain a current knowledge of campaign regulations, policies and procedures
Maintain current knowledge of all contract requirements and objectives
Maintain HIPAA Certification
Perform miscellaneous duties as assigned in a highly professional manner

Knowledge, Skills and Abilities Needed:

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
Member customer service background
Flexibility to handle any non-standard situations that may arise
Must be able to multitask

Required and Preferred Qualifications:

At least 4 years medical customer service
At least 1 year Medical claims processing and/or billing experience preferred.
High School diploma or equivalent is required

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.

Healthcare Customer Service Member Advocate

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