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Description
In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, you’ll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris.
Position:
Claims Analyst (Remote Nationwide)
Position Summary:
Coming Soon – JB
Job Description:
Role and Responsibilities
- Make outbound calls to obtain additional information required to process claims, when necessary
- Handles challenging situations and acts with appropriate level of urgency when necessary
- Processes claims through timely and accurate entry of data
- Follow precise instructions to process claims
- Completes assigned work and maintains production and quality metrics
- Ability to follow changing instructions
- Ability to interact with other departments in resolving issues
- Investigate and respond to complex issues for successful resolution of claims
- Research and resolve 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
- Perform side by side comparisons to determine corrected claim actions
- Issues form letters & forms, when appropriate
- Performs initial overpayment recoupment process in the overpayment application
- Understands complicated pricing calculations for medical and hospital claims processing
- Ability to learn and maintain knowledge of Medicare fee schedules as well as Federal, State and local healthcare regulations
- Ability to learn and maintain knowledge of medical benefits and how they are administered
Experience, Qualifications, and Education
- High school diploma or general education degree (GED)
- Bachelor’s degree preferred
- Demonstrated experience solving complex or ambiguous problems
- Demonstrated experience researching and understanding complex information such as government regulations, contracts, etc
- Ability to work independently in a fast-paced environment with competing priorities
- Demonstrated ability to communicate effectively through both written and verbal modalities
- Proficiency with business applications like the Microsoft Office Suite
- Demonstrated experience working with a 10-key and excellent keyboarding skills
- Experience in Claim Processing is a plus
Lumeris is an EEO/AA employer M/F/V/D.
Location:
Addison, TX, Addison, TX, Ann Arbor, MI, Apollo Beach, FL, Arlington, TX, Atlanta, GA, Austin, TX, Baltimore, MD, Barrow, GA, Bartow, FL, Baton Rouge, LA, Boston, MA, Brandon, FL, Braselton, GA, Carson City, NV, Charlotte, NC, Chicago, IL, Clearwater, FL, Columbus, OH, Dade City, FL, Dallas, TX, Dayton, OH, Denver, CO, Detroit, MI, Durham, NC {+ 38 more}
Time Type:
Full time
Posted on :
2021-10-22T08:19:04Z
