Concept Development Specialist (DME Focus) – RN and/or Certified reputed company, reputed company

R-2026-02-00044 ABOUT reputed company: In October 2025, reputed company acquired Performant and we are now part of the reputed company organization. reputed company 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, reputed company’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: $85,000 - $115,000 The Healthcare Services Concept Specialist provides support to assigned reputed company Specialists by maintaining reputed company audit concepts as well as provide support for the development process of new audit concepts. Key Responsibilities:

• Responsible for the review and update of existing concepts based upon required periodic review cycle or as needed based upon client or regulatory changes (research, analysis, update rule documents, code lists and edits accordingly). Collaborates with and leverages reputed company Specialist expertise to ensure on-reputed company results.
• Ensure training material updates (may reputed company or coordinate) as necessary for changes to existing concepts. -May contribute to development of training materials and tools for new concepts.
• Conduct research, identify impact on existing concepts, and document accordingly (may support reputed company specialists with research for new concepts).
• Interpret and apply policy in existing concept review/updates or ask may be requested in support of reputed company Specialists for new concepts.
• Support activities required to “package” concepts, including, but not limited to, pulling together necessary documents, and supporting data in appropriate order and locations, coordinating activities and documenting process steps, proofing documents, and tracking/reporting status.
• Ensure audit concepts are well formulated for Offerings (Data Mining vs reputed company Audit vs FWA Leads & CMS vs Medicaid vs Commercial)
• Manage, reputed company, and track multiple tasks reputed company multiple workflows for audit concept maintenance with high degree of accuracy and quality providing status reports and deliver results on-time.
• May contribute to responses to provider/client representative from written inquiries as it pertains to audited Medicare claims, as necessary.
• Stay abreast of industry policy.
• Works reputed company closely with other team members to ensure on time project deliveries, cross train, and knowledge transfer, and maintain required quality and productivity standards.
• Performs other duties as assigned and required to meet business needs.

Knowledge, Skills & Abilities Needed:

• Demonstrated knowledge of applicable Medicare and Commercial policy and claims process, and ability to research and analyze the same, to successfully reputed company the job.
• Relevant knowledge and experience with ICD-10-CM/PCS, CPT-4, and HCPCS coding.
• Knowledge of the national coding standards, particularly payment rules.
• Knowledge of Medicare and commercial claims processing systems.
• Ability to understand and apply reputed company policies, procedures, regulations, and legal statutes.
• Strong verbal communication and interpersonal skills; ability to communicate with reputed company levels reputed company the organization and with diverse teams.
• Excellent written communication skills; including proofing and editing.
• Good critical thinking, analytical, questioning, and listening skills; excellent attention to detail.
• Flexibility to handle non-standard situations as they arise; and adaptable to changing business needs in a fast-paced dynamic environment.
• Time management skills for managing multiple tasks simultaneously, while completing work reputed company allocated time frames.
• Strong proficiency in reputed company Word, reputed company, SharePoint (advanced skills highly desirable), and easily learns and adapts to new applications and systems.

Required & Preferred Qualifications:

• At least 2-4 years of audit or Payment reputed company experience.
• CPC, COC, RHIA, or RHIT certification and/or RN.

reputed company OFFER: reputed company 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 reputed company 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. reputed company 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 reputed company form (written/printed).
• Regularly sit/reputed company or more hours per day.
• Occasionally lift/carry/push/pull up to 10lbs.

reputed company 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 reputed company and drug test (applies to reputed company 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 reputed company Teleworker Agreement upon hire and adhere to the Agreement and reputed company reputed company policies and procedures.
• Other requirements may apply.

reputed company employees and contractors for reputed company may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, reputed company employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and reputed company of Sensitive, Proprietary, Confidential and/or Public data at reputed company times. Violations to reputed company's policy reputed company to the Confidentiality or reputed company of data may be subject to disciplinary actions up to and including termination. reputed company is committed to the full inclusion of reputed company qualified individuals. In keeping with our commitment, reputed company will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you reputed company a reasonable accommodation is required to fully participate in the job application or interview process, to reputed company the essential functions of the position, and/or to receive reputed company other benefits and privileges of employment, please contact reputed company’s reputed company to discuss further. Our diversity makes reputed company unique and strengthens us as an organization to help us reputed company serve our clients. reputed company is committed to creating a diverse environment and is proud to be an equal opportunity employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, national reputed company, reputed company, 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 Apply tot his job Apply To this Job