Career Openings
All candidates must meet our minimum employment standards and Federal Contractor requirements:
- Possess a High School Diploma or GED
- Be free of defaulted student loans, state or federal liens
- Able to pass a pre-employment background check including credit and criminal history
- Meet the stated minimums for the position (could include specialized education/training, degree, certification, etc.)
- Possess excellent communication skills - written, verbal, in-person or over the phone
- Some positions may require Federal Background Clearance
DCS Healthcare Services has the following job openings. Click on the link to see the job description.
Sr. Business Analyst at Livermore, CA
Business Informatics & Audit Medical Review Specialist at Livermore,CA
Business Informatics and Audit Supervisor at Livermore, CA
Medical Review Nurse at San Angelo, TX
Medical Review Specialist at San Angelo, TX
Medical Review Nurse/Coder at San Angelo, TX
Recruiter at San Angelo, TX
Benefits
Medical Review Nurse at San Angelo, TX (click
to apply)
- Assisting in strategically planning outreach material, timing, approach, and target audiences.
- Create training/outreach material such as power points, Webinar slides, conference call agendas.
- Assist in facilitating set up and/or scheduling conference calls/Webinars/on site visits.
- Hosting and/or conducting Webinars/conference calls/on site visits and conducting Q&A’s after the presentations (should co-chair these responsibilities with the Medical Director).
- Assist in creating and monitor material that will be put on our Web site such as the material and Q&As from past and future webinars/conference calls/on site visits; list or post past, current and future vulnerabilities.
- Assist with provider, provider associations, and ACs relationship management.
- Monitor processes, on going maintenance and improvements of the outreach program.
- Assist in establishing best communication methodologies, supervise, coordinate and problem solve providers concerns in a timely manner.
- Collaborates with technology, workforce to ensure efficiency and effectiveness of providers needs.
- Assist Customer Service Specialist (CSS) with complex calls and make referrals to Medical Director as necessary.
- Provide audit staff training.
- Track changes in coding and Medicare policies.
- Perform routine Quality Assurance: ensure review variance is minimized and monitor quality, timeliness and performance.
- Perform coding and complex claims reviews as time permits.
- Travel will be required.
- Maintain knowledge of contract goals, objectives and requirements.
- Other Duties as assigned.
Required Skills and Knowledge:
- Registerd Nurse (RN) currently licensed in the State of Texas with additional current certification in Utilization Review or Case Management.
- Subject matter expertise in Medicare reimbursement/ payment policies, medical chart review and analysis, and medical terminology.
- Ability to apply (InterQual, Milliman) practice management guidelines to determine medical necessity, and appropriateness of coding and billing.
- Ability to research complex issues pertaining to Medicare benefits and coding/billing policies / practices. Able to synthesize the information, concisely communicate either verbally or in writing findings and recommendations.
- Strong presentation skills. Comfortable in presenting /defending audit logic to client and stakeholders ( i.e. hospitals, physicians).
- Ability to identify billing and payment discrepancies for Inpatient/Outpatient Hospital, SNF, IRF, Psych.
- In depth knowledge of ICD-9, DRG, CPT Coding, HCPCS, Revenue Codes, Coding Clinic and medical terminology.
- Strong analytical skills.
- Outstanding people skills and ability to effectively communicate review findings /results with management, or providers, customers.
- Strong verbal and written communication skills.
- Proficient on PC and related software programs.
- Excellent organizational skills.
Experience:
- Registerd Nurse (RN) currently licensed in the State of Texas with additional current certification in Utilization Review or Case Management.
- 3 year Medical claims processing and/or claims billing experience
Medical Review Nurse/Coder at San Angelo, TX (click
to apply)
The Nurse/Coder performs retrospective claim audit reviews on Medicare
claims for DRG and Clinical validation. You will work in a fast paced and dynamic environment
and be part of a multi-location team. The successful candidate will be a team player able to
collaborate with a variety of different entities to solve problems and generate solutions.
Responsibilities:
- Auditing Medicare claims for medically appropriate services provided in both inpatient and outpatient settings
- Conduct Coding reviews
- Conduct Clinical reviews
- Develop and maintain professional working relationships with the DCS team.
- Assist in educating the DCS Team members on coding, policies, regulations, appeal strategies etc.
- Serve as a resource to CCS staff and escalated provider calls.
- Enter and update all contact and/or review findings and supporting documentation into MARS. Documenting all findings referencing the appropriate policies and rules
- Notify management of:
- all correspondence indicating displeasure with the RAC, in the overpayment identification, or in the recovery methods utilized,
- legal action
- government intervention
- Applying appropriate Medicare policy and rules
- Generating letters articulating audit findings
- Supporting your findings during the appeals process if requested
- Work with the project team to minimize appeals
- Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse
- Work in partnership with CMS, CMD colleagues, and other Medicare contractors on improving Medicare policies, provider education, and system edits
- Collaborate policies and procedures pertinent to the RAC review process
- Keep abreast of medical practice, changes in technology, and regulatory issues that may affect the RAC contract
- Suggest ideas that may improve work flow
- Assist with QA functions
- Participate in development of Medical Review Guidelines
- Assist with training review team members
- Interface with and support the Medical Director
- Cross train in all clinical departments/areas
- Maintain coding and HIPAA Certification
- Perform miscellaneous duties as assigned in a highly professional manner
- Attend conference calls and all meetings as requested.
Required Skills and Knowledge:
- Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
- Active unrestricted RN license in good standing
- Strong preference for experience performing utilization review
- Experience with utilization management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG), Millimen or InterQual
- Experience with ICD-9, HCPCS/CPT, DRG coding
- Proficient in the use of HCFA/UB forms
- Knowledge of the Medicare program, particularly the coverage and payment rules
- Ability to maintain high quality work while meeting strict deadlines.
- Excellent written and verbal communication skills
- Not currently sanctioned or excluded from the Medicare program by the OIG
- Ability to manage multiple tasks including desk audits and claims review
- Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings
- Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members
- Strong knowledge of medical documentation
- Courteous, professional, and respectful attitude
- Possess knowledge of CMS rules and regulations.
- Flexibility to handle any non-standard situations that may arise
Experience:
- Minimum of three years diversified nursing experience providing direct care in an inpatient or outpatient setting
- Previous Medical claims processing, and/or medical customer service
- 2+ years experience coding for an inpatient facility/SNF Facility
- Thorough working knowledge of CPT/HCPCs/ICD-9/DRG coding
- One or more years experience performing medical records review
- One or more years experience in health care claims that demonstrates expertise in, ICD-9 coding, HCPS/CPT coding, DRG and Medicare claims data such as for medical billing experience for an Insurance Company or hospital required
Medical Review Specialist at San Angelo, TX (click
to apply)
Answer customer service inquiries, assist in identifying vulnerabilities,
and performing coding reviews. Additionally they will be knowledgeable of all contract goals,
objectives and requirements.
- Conduct Coding reviews.
- Facilitate and process requests from and/or to the DCS Team
- Make necessary contacts and/or perform necessary research to validate provider contact information
- Contact healthcare providers on overpaid claims and maintain collection records and account status updates
- Develop professional working relationships with colleagues, healthcare providers and other Medicare contractors.
- Establish good contact with providers to guarantee proper claim presentation and follow up
- Enter and update all contact and activity information into MARS where not automatically completed by the system, e.g., a telephone call is made, recorded, and attached to the case file in MARS, but the outcome must be extracted from the call and input into MARS
- Notify management of:
- all correspondence indicating displeasure with the RAC, in the overpayment identification, or in the recovery methods utilized,
- legal action
- government intervention
- Research and route internal/external communications to the appropriate person or department, including referrals received from Medicare contractors and documents, calls, and faxes sent to Medicare contractors by mistake
- Conduct critical due diligence follow-ups of unread media
- Answers questions from providers and resolves issues via phone and written correspondence
- Educating providers on their appeal rights
- Communicate with other staff/departments as necessary
- Report and validate debts ineligible for referral by category to management
- Maintain a current knowledge of all Medicare rules, regulations, policies and procedures
- Maintain current knowledge of all contract requirements and objectives
- Maintain HIPAA Certification
- Conduct simple coding reviews
- Perform miscellaneous duties as assigned in a highly professional manner
Minimum Qualifications:
- Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P
- Excellent verbal and written communication skills
- Skilled in data entry and knowledge of computers
- Courteous, professional, and respectful attitude
- Strong understanding of customer service policies and processes
- Basic understanding of accounts payable and receivable
- Possess knowledge of CMS rules and regulations
- Knowledgeable of the uses of ICD-9, HCPCS/CPT codes
- Proficient in the use of HCFA/UB forms
- Flexibility to handle any non-standard situations that may arise
- Must be able to multi task
Experience:
- Previous Medical claims processing, and/or medical customer service
- 2+ years experience coding for an inpatient facility/SNF Facility
- Thorough working knowledge of CPT/HCPCs/ICD-9 coding
Recruiter at San Angelo, TX (click
to apply)
The Recruiter is responsible for ensuring business requirements for staffing are met according to targets and business fluctuations, focusing on production, professional and support job types.
Job Duties:
- Screen and interview candidates
- Coordinate local ad schedule & placement
- Coordinate with Staffing Admin on offers, candidate files, applicant tracking, etc.
- Proficient use of HRIS, including reporting, creation of recruiting events, ad expense tracking and general data
- Maintain compliance with federal and state regulations concerning employment.
Required Skills & Knowledge:
- Degree in business or related field, or combination of education and experience (2+ years recruiting experience)
- Hands-on experience in Internet and traditional recruiting, ability to manage high-volume of job requisitions and candidate responses in an accurate and timely manner
- Excellent communication and presentation skills
- Solid office skills, including Microsoft suite of products and ability to use other applications (resume tracking programs, internally developed products, etc)
- Ability to juggle multiple efforts, establish own priorities and work in a team oriented environment
- Ability to work independently, apply good judgment and guide the work of others
- Project management skills a plus
Sr. Business Analyst at Livermore,CA (click
to apply)
We are looking for an analytical minded, operational, individual that wants to make a difference on a national level. We are DCS Healthcare, we are one of four National CMS Medicare Recovery Audit Contractors (CMS/RAC). Our goal is to become a key driver behind controlling the growth medical costs. CMS has contracted with us to find over payments, miss payments, and abusive billing practices for the Northeastern region of the United States. CMS’s goal is to reduce the cost of Medicare and help reform the system. The individual we are looking for is someone that can perform the systems analysis for the team, someone that wants to see their efforts having a direct impact. Their job will be to understand both the operational processes, as well as the technical issues, and to make recommendations and designs to achieve our goals. Skills we are looking for are (1) a drive to understand how things currently work, (2) intellect to figure out the optimal solution, be it procedural changes or technical enhancements, (3) ability to communicate these solutions in writing and presentations, (4) persistence to manage competing demands, (5) and resilience to work with a set of other dynamic individuals.. To be clear, this is a hands-on-job, we are looking for someone that wants to take action, see results, and have an impact.
Responsibilities:
- Work closely with user community to understand business processes management and the business requirements of internal customers and translating them into specific software requirements.
- Work closely with development team and other stakeholders throughout the Software Development Life Cycle (SDLC).
- Focus on CMS Recovery Audit Contractor projects.
Essential Job Duties:
- Work closely with business users, managers and executive to understand business processes and automation needs.
- Clarifies internal customers’ requirements, business needs and project objectives, via feedback session and customers meeting, in collaboration with all stakeholders.
- Quickly understands the business issues and data challenges of the project.
- Perform liaison duties between project team and users on scope issues of a project.
- Develop block diagrams, user charts, logic flowcharts, data flowcharts, and other diagrams in order to communicate the needs of the customer and to create a clear written explanation of the need.
- Deliver professional requirements documents for developers to start designing and coding.
- Work closely with development team and other stakeholders throughout the Software Development Life Cycle (SDLC).
- Identify organization's strengths and weaknesses and suggest areas of improvement.
- Review and edit requirements, specifications, business processes and recommendations prepared by other developers in the group.
- Develop the project return on investment and other financial justifications.
- Help Design systems and/or approaches, and required enhancements.
- Work with users and release control group to control release the products and monitor for any issues while in controlled release.
- Modify or update requirements documentations as needed during the SDLC.
- Operate under minimal supervision.
- Travel will be required.
Minimum Qualifications:
- Knowledge and experience in developing strategic information systems plans.
- Experience with PC’s Microsoft Windows and/or UNIX development tools.
- Familiar with MS Project, Visio, MS Office and other diagramming and project management tools.
- Excellent knowledge of basic programming, system analysis, and programming languages.
- Excellent communication skills, including oral, writing, and editing.
- Able to work independently and meet deadlines with minimal supervision.
- Must have superior skills in the disciplines associated with technical documentation (e.g. formatting, versioning, editing, template creation, and security.)
Experience:
- 7-10 years of experience as a business analyst
- 2-4 years of project management experience in a software development environment.
- Experience with Agile, Scrum and traditional Waterfall software development methodologies.
- Experience / knowledge of health insurance/medical industry/ Medicare and Medicaid programs will be advantageous
Education:
- Minimum Bachelor’s degree in business or computer science.
- Completion of short term training in advanced programming and project management areas will also be considered as a positive.
Business Informatics and Audit Supervisor at Livermore, CA (click
to apply)
Position Focus/ Essential Job Duties:
Responsible for Business Informatics & Audit team members. Reports directly to the Business Informatics & Audit Director ensuring deliverables for the department.
Job duties to include:
- Translate audit strategy into a measurable and well articulated set of tactics which will include leading and managing /supervising the following :
- Query development and refinement – done in conjunction with the data analytics team
- Audit support – identification and articulation of likely improper payments scenarios and applicable Medicare billing guidelines to support audit parameters
- Work closely with the team Director to evaluate audit results
- Develop methodologies and processes for revising audit selection criteria to maximum audit impact on new issue selection
- Work closely with the Medical Director(s), Business Informatics and & Audit Director to ensure the strategy is QA’d and implemented appropriately
- Research new payment vulnerabilities and track applicable Medicare communication on improper payments
- Strategic planning and developing new issues packages for submission to assist in growth of the company.
- Apply appropriate Medicare policies and rules to audit issue development
- Analysis of reports, organizing and collating it into meaningful result recommendations
- Work collaboratively with IT to provide completed selection criteria available for production
- Keep abreast of medical practice, changes in technology and regulatory issues that may affect RAC issues
- Complete any & all tasks as assigned in a highly professional manner
Minimum Qualifications:
- Supervisor experience including team development and change management
- Strong preference for experience performing utilization or case management review for an insurance company, CMS contractor, i.e. MAC or other organizations performing similar functions
- Strong preference for a background in data /report analysis, data mining related to claims adjudication
- Experience with utilization/case management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual
- Experience with ICD-9, CPT-4 or HCPCS coding. Coding certification is a plus.
- Possess knowledge of CMS rules and regulations.
- Strong knowledge of medical documentation requirements relative to reimbursement , i.e. Medicare/Medicaid preferred
- Knowledge of the Medicare program, particularly the coverage and payment rules
- Not currently sanctioned or excluded from the Medicare program by the OIG
- Active unrestricted RN license in good standing
- Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members
- Courteous, professional, and respectful attitude
- Flexibility to handle any non-standard situations that may arise
Experience:
- Minimum of 5 years of supervisor or management experience
- Minimum of three years diversified clinical , insurance and/ or direct CMS experience
- Three plus years experience data /report analysis, data mining related to claims adjudication and experience with utilization/case management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual
- Three plus years experience with ICD-9, CPT-4 or HCPCS coding. Coding certification is a plus.
- Three plus years experience with CMS rules and regulations
Business Informatics & Audit Medical Review Specialist at Livermore, CA (click
to apply)
Position Focus/ Essential Job Duties:
- Apply appropriate Medicare policies and rules to audit issue development
- Serve as the liaison for CMS and contractors
- Analyze reports, organizing and collating into meaningful result recommendations
- Identify potential audit areas and researching related to audits issues to provide completed selection criteria available for production
- Responsible for all QA processes and website
- Keep abreast of medical practice, changes in technology and regulatory issues that may affect RAC issues
- Interface with Contractor Medical Director
- Work collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse as requested
- Collaborate policies and procedures pertinent to the RAC review process
- Assist with training review team members as requested
- Perform duties as assigned in a highly professional manner
Minimum Qualifications:
- Strong preference for experience performing utilization or case management review for an insurance company, CMS contractor, i.e. MAC or other organizations performing similar functions
- Strong preference for a background in data /report analysis, data mining related to claims adjudication
- Experience with utilization/case management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual
- Experience with ICD-9, CPT-4 or HCPCS coding. Coding certification is a plus.
- Possess knowledge of CMS rules and regulations.
- Strong knowledge of medical documentation requirements relative to reimbursement , i.e. Medicare/Medicaid preferred
- Knowledge of the Medicare program, particularly the coverage and payment rules
- Ability to maintain high quality work while meeting strict deadlines.
- Excellent written and verbal communication skills
- Not currently sanctioned or excluded from the Medicare program by the OIG
- Active unrestricted RN license in good standing
- Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings
- Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members
- Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members
- Flexibility to handle any non-standard situations that may arise
- Courteous, professional, and respectful attitude
Experience:
- Minimum of three years diversified clinical , insurance and/ or direct CMS experience
- Three plus years experience data /report analysis, data mining related to claims adjudication and experience with utilization/case management systems or clinical decision making tools such as Medical Coverage Guidelines (MCG) or InterQual
- Three plus years Experience with ICD-9, CPT-4 or HCPCS coding. Coding certification is a plus.
- Three plus years experience with CMS rules and regulations
Benefits
Performant Financial Corporation is a highly professional, yet fun and energetic team-oriented environment. We value commitment, diligence, experience, and self-motivation. Our compensation structure is highly competitive. Employees receive excellent benefits, including:
- Medical / Dental / Vision
- Paid Life Insurance
- 401(k) Plan
- Vacation and Holiday Pay
- Disability Coverage
- Employee Assistance Program
- Flexible Spending Accounts
- Corporate Discounts