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, Payer Relations will have strong knowledge of healthcare claims, eligibility, medical terminology, Coordination of Benefits and Third-Party Liability (COB/TPL). This position will lead a team of Payer Relations and Eligibility Specialists responsible for supporting Performant's Eligibility and Recovery business.

Key Responsibilities to include:

• Understand and be able to apply state and federal laws and regulations that impact Performant's eligibility and claiming products and services.

• Identify, prioritize, and lead outreach efforts for healthcare community stakeholders to facilitate eligibility data sharing and claims processing.

• Review and analyze Trading Partner data to identify trends, patterns, and opportunities for improvement.

• Create and maintain appropriate contracting vehicles for eligibility data sharing, claims processing, and other situations needed to accomplish Performant's business objectives.

• Understand and be able to apply legal changes, guidelines, and other information that could impact Performant's eligibility business.

• Performs internal and external research and supports or leads a variety of projects in support of TPL Regulatory and Outreach function.

• Collaborates with leadership to provide effective and detailed analysis required for optimal business operations.

• Maintains a strong team through meetings, training, coaching, mentoring and other development techniques.

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

• 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.

• 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.

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

Knowledge, Skills and Abilities Needed:

• Knowledge of and ability to work with healthcare eligibility data.

• Strong working knowledge of healthcare coordination of benefits and how legal, compliance, and regulatory requirements and guidelines may affect recovery and eligibility management.

• Strong written and verbal communication skills; demonstrates effective professional communication with internal and external audiences.

• Exceptional relationship management and interpersonal skills with a positive attitude.

• Strong analytical ability, and keen attention to detail

• Highly skilled in project management and documentation.

• Knowledge of healthcare medical and pharmacy claims

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

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

• General SQL skills to query and test

• General knowledge of X12 EDI Transactions, including, but not limited to 270/271 and 834.

• Professional verbal and written communication with good presentation skills

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

• Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail

Required and Preferred Qualifications:

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

• 5+ years relevant experience working with healthcare data.

• 3+ years management or supervisory experience

• 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