We are looking for more experienced, smart, talented, passionate, loyal, and fun-loving individuals to become "Lucent Health" - the face, the voice, and the behavior that represents the quality of who we are to those we serve!
Essential Duties and Responsibilities: include the following. Other duties may be assigned.
- Processes medical claims accurately, efficiently, timely, and within quality/quantity requirements.
- Exhibits an attention to detail and a strong work ethic.
- Has the ability to interpret Plan Documents and apply appropriately in the processing of claims.
- Has the ability to access research tools for accurate claims entry.
- Is able to be organized and manage time and resources efficiently and effectively.
- Has thorough knowledge and use of coding structures (CPT, HCPCS, Revenue codes, ICD 9/10 etc.).
- Has the ability to perform arithmetic calculations
- Has knowledge of COB.
- Exercises expert knowledge of benefits and benefit calculations.
- Has the ability to understand all types of claims pricing (Network, Medicare, RBP (Reference Based Pricing) and UCR (Usual, Customary and Reasonable, etc.).
- Performs duties in a HIPAA compliant manner.
- Participates as a Team Member to ensure the smooth operation of the entire department.
- Maintains guidelines and notes with attention to detail to enable accurate claims processing.
- Maintains quantity/quality department goals regarding the number of claims entered and accuracy percentages.
- Has the skills to proficiently use a computer and associated databases and software applications.
- Completes other projects as assigned.
- Complies with department policies and procedures.
- Assists in cross-training other employees at the management’s request.
- Performs special projects at the request of management.
- Regular, predictable attendance is required.
- Has the ability to get along and work effectively with others.
- Ebix LuminX database experience, desired.
Supervisory Responsibilities: This job has no supervisory duties.
- Desired Experiences / Background:
- 5+ years medical Claims Processing
- 5+ years healthcare claims pricing
- Working knowledge of claims pricing related to Networks, RBP, UCR
- 5+ years detailed knowledge and understanding of medical coding structures
- Experience working in self-funding and third party administration healthcare environment, preferred
Equal Employment Opportunity Policy Statement
Lucent Health Solutions, LLC is an Equal Opportunity Employer that does not discriminate based on actual or perceitve race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identify, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities, and general treatment during employment.