Sr. Business Operations Analyst

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:

We are seeking a Sr. Business Operations Analyst with strong knowledge of healthcare claims, medical terminology, eligibility validation practices, Coordination of Benefits and Third-Party Liability (COB/TPL), or Medicare Secondary Payer (MSP). This position will also support new client implementations and existing programs with requirements gathering related to healthcare claims data.

Key Responsibilities:

• Leverage knowledge and expertise in COB/TPL/MSP to analyze claims data.

• Perform detailed analysis to identify trends, patterns to improve existing processes.

• With minimalize supervision conducts analysis to support business decision making

• Assist technical and business leads with requirements gathering and documentation for new implementations and existing program changes.

• Conducts a variety of data analysis for intelligent insights using subject matter knowledge, independent judgement, and analytical expertise.

• Creates complex custom queries to meet reporting needs of internal and external stakeholders.

• Working independently conducts research, analyzes trends and activities, and presents data and findings based upon business needs and as need to identify opportunities, root causes of issues and to support business decisions and strategies.

• Performs QA and UAT as needed.

• Collaborates with technical and business leaders to minimize risks while increasing performance.

• Assists to with review of medical claims pre and post adjudication to identify business improvements and processes.

• 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.

• 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.

• Demonstrates Performant core values in performance of job duties and all interactions.

• Correct areas of deficiency and oversight received from quality reviews and/or management.

Knowledge, Skills & Abilities Needed:

• Knowledge of and ability to work with large volumes of eligibility and claims data.

• Working knowledge of healthcare medical and pharmacy claims, including billing requirements

• Experience with Medicaid / Medicare / Other TPL business models and products

• Knowledge of requirements gathering, ETL processing and data matching

• Robust system skills with ability to quickly develop expertise in new systems and applications.

• Advanced skills in Excel, Access, and/or other data analysis applications

• Proficiency with SQL skills to query and test

• Advanced knowledge of X12 EDI Transactions, including, but not limited to 270/271, 277, 837, 835.

• Professional verbal and written communication with good presentation skills

• Able to work independently and meet deadlines with minimal supervision.

• Strong problem solving and communication (written and oral) skills.

• Ability to produce results and maintain a positive attitude in fast paced, dynamic environment.

• Initiative-taking and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen diligence.

• Ability to develop and clearly communicate business rules to production engineers and developer.

• Make sense of complex systems to understand how things work and how problems arise.

• Identify areas for operational efficiency and recommend solutions for process improvements or automation.

Required & Preferred Qualifications:

• Bachelor’s degree in relevant field or equivalent combination of education and experience.

• 7+ years relevant experience working with healthcare claims data

• Experience with data modeling and analysis

• Knowledge and experience with Healthcare, Coordination of Benefits, Third Party Liability, and/or Medicare Secondary Payer

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