Performant Corp

Perform medical claims audit reviews for government and commercial payers to ensure services are medically appropriate. Document findings, generate audit letters, and support findings during the appeals process.

The Medical Review Clinical Appeals Auditor (RN) conducts Appeals reviews of new evidence presented by auditees and documents Appeals results according to quality policies. They also contribute to continuous improvement initiatives and may support training activities for new or existing staff.

The specialist serves as the primary contact for Medicare contractors and providers, delivering professional, accurate, and timely responses to inquiries via written, telephonic, and electronic means. Key duties involve maintaining knowledge of contract requirements, resolving complex issues via inbound calls, and conducting necessary research and follow-ups.

This role supports inventory management, process documentation, and production quality assurance for Eligibility operations teams by ensuring accurate inventory distribution and conducting compliance audits against internal, client, and regulatory requirements. The analyst will utilize SQL and subject matter expertise to test data flow, perform audits, create metrics reporting, and mentor operations and data teams on processes.