Manager of Healthcare Billing Recovery Operations Programs

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 Manager of Healthcare Billing Recovery Operations Programs is a strategic leader responsible for ensuring operational continuity, efficiency, and excellence across client programs. This role focuses on optimizing service delivery through expert knowledge of Medical Billing Recovery, Coordination of Benefits (COB), Third-Party Liability (TPL), and Medicare Secondary Payer (MSP) claims involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP). The manager brings a versatile skillset, operational leadership experience, and a commitment to continuous improvement in a dynamic business environment.

This role is ideal for a proactive, results-driven leader with a passion for healthcare operations, team development, and delivering exceptional client service in a fast-paced environment.

Key Responsibilities

Operational Leadership

• Lead and manage cross-functional teams to ensure compliance with client, regulatory (HIPAA, federal/state), and company standards.

• Drive operational excellence by developing and implementing best practices, tools, and resources aligned with client requirements and service level agreements (SLAs).

• Maintain up-to-date knowledge of evolving client and regulatory requirements to ensure operational readiness and responsiveness.

• Build and develop high-performing teams, ensuring appropriate staffing levels and resource scalability.

• Provide coaching, feedback, and performance management to enhance team effectiveness and professional growth.

• Represent the organization in client and stakeholder meetings, building credibility and fostering strong partnerships.

• Analyze operational data and trends to inform decision-making and strategic planning.

• Demonstrate integrity and accountability in delivering results and meeting commitments.

Operational Tools and Program Management

• Lead initiatives to evaluate, develop, and refine SOPs, operational policies, and performance metrics.

• Support quality certification efforts (e.g., CMMI) and internal/external audit readiness.

• Analyze client contracts and operational performance to identify opportunities for process improvement and change management.

• Drive cross-functional collaboration to implement enhancements in GHP, NGHP, Payment Processing, QA, Outreach, and other program areas.

• Serve as Quality Officer for MSP operations for the MSP CRC for CMS.

• Serve as designated point of contact for the Acuity application and TouchPoint vendor.

• Serve as the point of contact for MSPIC contractor engagement as it relates to QA activities

• Handle various reporting responsibilities (quarterly QA report, annual QA plan, etc.) for delivery to client CMS.

Additional Duties

• Participate in special projects and initiatives as assigned by leadership.

• Support business continuity by working on designated holidays or from assigned office locations as required.

• Obtain and maintain necessary government client clearances upon hire.

• Travel as needed.

Knowledge, Skills and Abilities Needed

• Strong understanding of Medicare Secondary Payer (MSP) regulations, including Group Health Plan (GHP) and Non-Group Health Plan (NGHP) claims.

• In-depth knowledge of quality assurance methodologies, audit processes, and compliance standards in healthcare operations.

• Ability to analyze data and trends to identify root causes, recommend corrective actions, and drive continuous improvement.

• Proficiency in developing and implementing QA tools, scorecards, and performance metrics.

• Excellent communication and interpersonal skills to collaborate across departments and present findings to leadership.

• Strong organizational and time management skills with the ability to manage multiple priorities in a fast-paced environment.

• Proficient in Microsoft Office Suite and QA tracking/reporting systems.

• Ability to lead and influence cross-functional teams and drive accountability.

Required and Preferred Qualifications

• 3-5 years of managerial experience in quality assurance or healthcare operations.

• Experience with MSP, COB, or TPL processes preferred.

• Bachelor's degree in healthcare administration, business, or a related field or equivalent work experience; advanced degree or certifications (e.g., CPHQ) preferred.

• Experience working in a CMMI or similarly structured quality framework is a plus.

WHAT WE OFFER:

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.

All employees and contractors for Performant Financial 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 Performant's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.

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