Healthcare Services Concept Specialist - RAC Focus (Certified Coder or RN)

Performant Healthcare, Inc.; United States; Remote; USD 78,000 - 104,000; Full time

Job summary

Performant Healthcare, Inc. is seeking a Healthcare Services Concept Specialist to support Segment Specialists by updating audit concepts and developing training materials. This role requires a strong understanding of Medicare and claims processes, and relevant certifications are essential for contributing effectively in a collaborative environment.

Benefits

Health coverage

401(k)

Paid leave

Holidays

Qualifications

• 2-4 years of audit or Payment Integrity experience required.
• Relevant coding certification or RN license needed.

Responsibilities

• Review and update audit concepts based on regulations.
• Develop training materials and conduct policy research.
• Respond to client inquiries about Medicare claims audits.

Skills

Medicare policies

Commercial claims processes

Coding (ICD-10-CM/PCS, CPT-4, HCPCS)

Communication

Attention to detail

Critical thinking

Adaptability

Education

CPC certification

COC certification

RHIA certification

RHIT certification

RN license

Tools

Microsoft Word

Microsoft Excel

SharePoint

Job description

Healthcare Services Concept Specialist - RAC Focus (Certified Coder or RN)

Join to apply for the Healthcare Services Concept Specialist - RAC Focus (Certified Coder or RN) role at Performant Healthcare, Inc.

About Performant
At Performant, we focus on helping our clients achieve their goals through technology-enabled services that identify improper payments and recoup or prevent losses caused by billing errors. We are the 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 what matters most—quality of care and healthier lives for all.

If you value People, Innovation, Integrity, Fun, and an Ownership Culture, Performant is the right place for you!

About The Opportunity

Hiring Range: $78,500 - $104,000

The Healthcare Services Concept Specialist supports Segment Specialists by maintaining current audit concepts and assisting in developing new ones.

Key Responsibilities

• Review and update existing concepts based on periodic reviews or changes in regulations or client needs, collaborating with Segment Specialists.
• Update and develop training materials for existing and new concepts.
• Conduct research on policy impacts, document findings, and support the development of new concepts.
• Interpret policies and support the packaging of audit concepts, including document preparation and process tracking.
• Ensure audit concepts are tailored for different Offerings and manage multiple tasks with high accuracy and timeliness.
• Assist in responding to provider or client inquiries related to Medicare claims audits.
• Stay informed on industry policies and collaborate with team members to ensure timely project delivery and knowledge sharing.
• Perform other duties as needed to meet business objectives.

Knowledge, Skills & Abilities

• Strong understanding of Medicare and Commercial policies, claims processes, and coding (ICD-10-CM/PCS, CPT-4, HCPCS).
• Knowledge of coding standards and claims processing systems.
• Ability to interpret complex policies and communicate effectively at all organizational levels.
• Excellent written and verbal communication skills, attention to detail, critical thinking, and adaptability.
• Proficiency in Microsoft Word, Excel, SharePoint, and ability to learn new systems.

Qualifications

• 2-4 years of audit or Payment Integrity experience.
• Certification such as CPC, COC, RHIA, RHIT, or RN license.

Additional Information

Performant offers comprehensive benefits, including health coverage, 401(k), paid leave, holidays, and more. Reliable high-speed internet is required for remote work. All employees must pass background checks and adhere to client and company policies. We are committed to diversity and inclusion, providing reasonable accommodations as needed. This job posting is active and not expired.