What are the responsibilities and job description for the Medical Director position at Performant Corp?
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 Medical Director will have responsibility for providing medical oversight and leadership for the company’s healthcare audit and recovery business for both government (CMS RAC) and commercial clients. Position could include direct management of medical directors and/or associate medical directors as Performant scales the Healthcare team.
The MD will leverage his/her medical clinical expertise, extensive knowledge in Medicare, Medicaid, and private payer rules and regulation, policies and procedures, business acumen, and industry knowledge to influence decision making and operations in the best interest of the company for our healthcare business and to meet contractual requirements to clients.
Key Responsibilities
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.
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:
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
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 Medical Director will have responsibility for providing medical oversight and leadership for the company’s healthcare audit and recovery business for both government (CMS RAC) and commercial clients. Position could include direct management of medical directors and/or associate medical directors as Performant scales the Healthcare team.
The MD will leverage his/her medical clinical expertise, extensive knowledge in Medicare, Medicaid, and private payer rules and regulation, policies and procedures, business acumen, and industry knowledge to influence decision making and operations in the best interest of the company for our healthcare business and to meet contractual requirements to clients.
Key Responsibilities
- Member of Healthcare leadership team.
- Provides leadership and advice to management and audit staff.
- Regular external interaction with government agencies, customers, vendors and subcontractors
- Maintain current knowledge of trends and issues in medical practice, technologies and impact on payment integrity.
- Provide expertise and sound judgment on interpretation and application of the Medicare, Medicaid, or private payer rules, regulations, policies and procedures.
- Provide medical expertise and actively contribute to decisions for workflow, guidelines and resources to meet contract requirements.
- Identify opportunities for increased efficiencies to processes, systems and tools, leveraging operational reports and analysis.
- Apply strong business acumen to conduct reviews and takes initiative for recommendation and action to mitigate risks.
- Partner with Analytics and Audit Concept Development teams to provide consultative oversight identification of audit concepts to pursue.
- Partner with applicable management to provide guidance in development of process, training and guidelines for conducting medical review and audit, including complex reviews.
- Provide oversight and participation in provider outreach and appeals processes, including but not limited to provider notifications, doc-to-doc discussions, and ALJ hearings.
- Build collaborative relationships working with CMS, commercial healthcare providers, as well as internal and subcontracted management and staff associated with the company’s medical review and audit business.
- Participate in provider, CMS, RAC and external partner meetings.
- Collaborate internally to contribute to building best practices.
- Identification and submission to CMS of major issues/vulnerabilities having significant impact on Medicare.
- Interaction with Medical Directors of other contractors and/or RACs to share information on potential problem areas, participate in presentations to providers or associations, or workgroups as may be required.
- Leverage relational network and insights to payer environments to identify opportunities to expand Performant footprint.
- Support the sales and marketing teams as required providing medical and/or policy expertise.
- Provide expertise and contribute to strategies for presenting appropriately and strengthening the company position within the government and commercial healthcare communities.
- Ensure appropriate skills and specialty experience is represented in the team of regular employees, contractors, or subcontractors to provide required medical oversight to support the diverse client and business needs, in a manner that is in the best interest of the company.
- Provides coaching, feedback and holds accountability for results and behaviors.
- Serves as positive role model and leads by example in alignment with company mission, vision and values.
- Develops implementation strategy, plan and resource requirements for new accounts or project.
- Strong working knowledge of the Medicare (Part A, Part B, DME, Home Health & Hospice preferred), Medicaid, and private payer rules, regulations, coverage determinations, policies and procedures.
- Significant operating knowledge of CMS and applicable functions of MAC, QIO, RVC, and RA
- Public relations experience such as working with physician groups, beneficiary organizations or Congressional offices.
- Strong business acumen coupled with analytical and critical thinking abilities.
- Exceptional influencing, facilitation, and interpersonal communication skills one-on-one and in group settings.
- Possess ability to work in team environment where collaboration to solve problems, generate solutions and the knowledge transfer process are critical for success.
- Ability to build strong relationships both internal and external to the organization.
- Ability to deal well with ambiguity. Can effectively shift gears comfortably, can decide and act without having the total picture, comfortable handling risk and adversity.
- Demonstrates good judgment by anticipating the consequences of actions and weighing multiple, sometimes conflicting, priorities.
- Ability to act with confidence, make good decisions in the best interest of the company and drive results given direction in the form of assigned goals objectives.
- Able to solve complex problems, and resolve disagreements with informed, rational debate.
- Builds credibility and trust.
- Mind-set of continuous improvement and adapts quickly to change.
- Strong management skills in coaching, mentoring and training.
- Ability to operate effectively and impact positively in a fast-paced and dynamic environment, as part of a multi- location team.
- Experience in a MD role with CMS and/or with a prime contractor working with CMS as RAC, MAC, QIO, or RVC.
- Experience in the commercial health insurance industry or healthcare consulting/servicing firm
- Public relations experience with physician groups, beneficiary groups or Congressional offices.
- Experience leading and managing Medical Directors and/or other senior non-clinical healthcare staff.
- Experience practicing medicine as a board-certified Doctor of Medicine or Doctor who is currently licensed to practice medicine, with no previous sanctions or exclusions from the Medicare program.
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.
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
