Job details
Job type full-time
Full job description
In order to apply for a position at lumeris, you must create an account using your email address and a password of your choosingThis account will allow you to receive notifications each step of the way through the job application processWith these updates, you’ll never have to wonder where you are in the processAdditionally, we can easily send pertinent documents to you for your reviewOnce you create the account, you may apply to any position you feel is a good fit without having to re-enter informationThank you for your interest in lumeris.
Position:
Claims analyst (remote - nationwide)
Position summary:
The claims analyst is a part of the services team and is responsible for researching and processing moderately complex claimsThese claims are both paper and electronic and follow cms guidanceThe claims analyst applies specific and market focused processes to provide service support to clients as neededThis role includes solving claims issues, detailed reporting, adjustments and escalations.
Job description:
Primary responsibilities
Investigates and processes moderately complex claims
Handles challenging situations and acts with appropriate level of urgency when necessary
Follows precise instructions when processing claims
Completes assigned work and maintains production and quality standards
Extensively interacts cross-functionally to support resolution of claim issues
Researches and resolves adjustment inquiries
Performs edit resolutions from pended paper and electronic claims using critical decision-making skills for accurate claims processing
Works complicated reports, which involves critical decision making on adjustments, overrides of copayments, coinsurance, correct pricing and provider selection
Performs side by side comparisons to determine corrected claim actions
Issues letters & forms when appropriate
Performs initial overpayment recoupment process in the overpayment application
Qualifications
High school diploma or general education degree (ged)
3+ years of experience in a related role
Basic knowledge and understanding in operational processes and complicated pricing calculations for medical/hospital claims processing
Demonstrated experience researching and understanding complex information (such as government regulations, contracts, etc.), as well as solving complex or ambiguous problems
Strong attention to detail and experience with analyzing
Ability to work independently in a fast-paced environment with competing priorities
Flexibility and adaptability to frequently changing guidelines and processes
Ability to learn and maintain knowledge of medical benefits and how they are administered and medicare fee schedules, as well as federal, state, and local healthcare regulations
Demonstrated ability to collaborate with internal and external stakeholders and communicate effectively through both written and verbal modalities
Proficiency with business applications like microsoft office suite
Demonstrated experience working with 10-key and excellent keyboarding skills
Preferred qualifications
Experience in claim processing is a plus
Bachelor’s degree preferred
Working conditions
While performing the duties of this job, the employee works in normal office working conditions.
Disclaimer
The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills requiredThe physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this jobReasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.
Lumeris is an eeo/aa employer m/f/v/d.
Location:
Remote - ak, remote - az, remote - de, remote - fl, remote - ia, remote - il, remote - la, remote - mn, remote - mo, remote - nc, remote - nj, remote - nv, remote - ok, remote - pa, remote - sc, remote - va, remote - wa, stLouis, mo
Time type:
Full time
