ABOUT MACHINIFY:
In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence.
ABOUT THE OPPORTUNITY:
Hiring Range: $19 - $20As a Healthcare Billing Recovery Case Specialist I (SCA), you will work Group Healthcare (GHP) and/or Non-Group Healthcare (NGHP) Provider delinquent accounts under the CMS Medicare Secondary Payer recovery program. The medical billing specialist in this role will come with strong knowledge of medical claim billing, medical terminology and medical coding, forms UB04 and CMS 1500, Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims, and procedural challenges regulations; experience generating or auditing medical claims and billing; proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; and communicate effectively with carriers to recapture payments.
Key Responsibilities
Review account claim and other documentation to verify payment liability for claims that may have been paid by Medicare in error.
Leverage your knowledge and expertise in medical billing/COB/MSP to review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action.
Initiate correct action with applicable party (health insurance carrier, auto/home/worker’s comp insurance carrier, or legal representative) and documentation based upon payment option, actions required if new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.
Updates client and/or company systems with clear and accurate information such as contact and updated demographic information, notes from contact dialog and attempts, payment commitment, as well as account status updates as applicable.
Initiates applicable claim activities; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.
Arrives to work on-time, works assigned schedule, and maintains regular good attendance.
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
Consistently achieve or exceed established metrics and goals assigned, including but not limited to, production and quality.
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.
Work overtime as may be required.
May be required to work some Performant holidays due to client requirement.
Performs other duties as assigned.
Knowledge, Skills and Abilities Needed
Knowledge and experience with medical claim billing procedures, medical terminology and medical coding, preferably in a role generating, auditing, recovery and/or researching the same.
Familiarity with information in forms UB04 and CMS 1500
Experience with Coordination of Benefits, Third Party Liability, Medicare Secondary Payer
Proven ability to gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues;
Ability to communicate professionally and effectively with providers, carriers, beneficiaries and other audiences regarding claims and billing payment.
Experience in handling Medicare and Medicaid claims.
Protected patients’ privacy, understands and adheres to HIPAA standards and regulations.
Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service attitude.
Self-motivated and thrives in a fast-paced business operations department performing multiple tasks cohesively, with keen attention to detail.
Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, individual coaching, etc.).
Ability to follow process, procedures and regulations in the workplace.
Ability to effectively perform work independently, and work cooperatively with others to promote a positive team environment.
Ability to adapt quickly and transition effectively to changing circumstances, assignments, programs, processes.
Ability to consistently perform job responsibilities.
Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening.
Completion of Teleworker Agreement upon hire, and adherence to the Agreement (including applicable policies and procedures), which includes, but not limited to, basic home office suitability requirements such as high-speed internet connectivity, appropriate work-space for compliance with confidentiality, HIPAA, safety and ergonomics, and work environment allowing dedicated work-focus without distraction during work hours.
Possess a personality type that is ethical, friendly, hard-working and proactive.
Required and Preferred Qualifications
Minimum 6 months of medical billing experience, including Medicare, demonstrating depth of knowledge and capability required for the position.
Minimum 2 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills.
High School diploma or GED is required.
WHAT WE OFFER:
Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with 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.
Machinify 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 Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.
Other requirements may apply.
All employees and contractors for Machinify 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 Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify 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 Machinify’s Human Resources team to discuss further.
Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify 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 UNLESS EXPLICITY AGREED TO IN WRITING