Healthcare Billing Recovery Case Specialist I (SCA)

Performant Healthcare, Inc.; United States; Remote; Full time

Job summary

A leading healthcare payment integrity company seeks a Healthcare Billing Recovery Case Specialist I (SCA) to manage provider delinquent accounts under Medicare. The role involves medical billing expertise, claims recovery, and compliance with healthcare regulations. Join a team dedicated to improving payment accuracy and client support.

Benefits

Health Coverage

401(k)

Paid Leave

Holidays

Qualifications

• Minimum 6 months of medical billing experience, including Medicare.
• Minimum 2 years in customer service, billing reclamation, or recovery roles.

Responsibilities

• Review account claims and documentation to verify payment liabilities.
• Coordinate with insurance carriers and legal representatives.
• Maintain compliance with policies, regulations, and client requirements.

Skills

Medical Billing

Communication

HIPAA Compliance

Education

High School diploma or GED

Job description

Healthcare Billing Recovery Case Specialist I (SCA)

Join to apply for the Healthcare Billing Recovery Case Specialist I (SCA) role at Performant Healthcare, Inc.

About Performant

At Performant, we focus on helping clients achieve their goals by providing technology-enabled services to identify improper payments and recover or prevent losses due to billing errors. We are a leading independent healthcare payment integrity company in the US, serving markets including Medicare, Medicaid, and Commercial Healthcare. Our mission is to offer innovative payment accuracy solutions that enable our clients to focus on quality care and healthier lives.

About The Opportunity

Hiring Range: $19 - $21/hr.

As a Healthcare Billing Recovery Case Specialist I (SCA), you will handle Group Healthcare (GHP) and Non-Group Healthcare (NGHP) provider delinquent accounts under the CMS Medicare Secondary Payer recovery program. The role requires strong knowledge of medical billing, coding, and related regulations, as well as experience in claims review and communication with carriers to recover payments.

Key Responsibilities

• Review account claims and documentation to verify payment liabilities, especially for claims paid by Medicare in error.
• Utilize your expertise in medical billing, COB, MSP to evaluate and build case files, respond to defenses, and initiate appropriate account actions.
• Coordinate with insurance carriers and legal representatives, updating systems with accurate information and following up to ensure timely and correct actions.
• Support internal teams with EOB interpretation and develop healthcare billing knowledge.
• Maintain compliance with policies, regulations, and client requirements, including HIPAA.
• Achieve performance metrics related to productivity and quality.
• Complete required training, clearances, and screenings, and adhere to confidentiality policies.

Knowledge, Skills, and Abilities

• Experience with medical billing procedures, coding, and claims recovery.
• Familiarity with UB04 and CMS 1500 forms, COB, TPL, and MSP claims.
• Strong communication skills and ability to handle Medicare and Medicaid claims.
• Understanding of HIPAA and confidentiality standards.
• Proficiency with office technology and online tools.
• Ability to work independently and as part of a team, with adaptability to change.

Qualifications

• Minimum 6 months of medical billing experience, including Medicare.
• Minimum 2 years in customer service, billing reclamation, or recovery roles.
• High School diploma or GED required.

Benefits & Requirements

Performant offers comprehensive benefits including health coverage, 401(k), paid leave, and holidays. Access to reliable high-speed internet is required for remote work. Must pass background checks and comply with client and company policies, including confidentiality and security standards.

We are committed to diversity and equal opportunity employment. Reasonable accommodations are available for applicants with disabilities. Third-party recruitment agencies are not accepted.