Provider Claims Pricing Specialist

About Lantern

Lantern is the specialty care platform connecting people with the best care when they need it most. By curating a Network of Excellence comprised of the nation's top specialists for surgery, cancer care, infusions and more, Lantern delivers excellent care with significant cost savings to employers and their workforces. Lantern also pairs members with a dedicated care team, including Care Advocates and nurses, for the entirety of their care journey, helping them get back to good health, back to their families and back to work. With convenient access to specialists nationwide, Lantern means quality care is within driving distance for most. Lantern is trusted by the nation's largest employers to deliver care to more than 6 million members across the country. Learn more about us at lanterncare.com. 

About You:

• You use LOGIC in your decision making and understand that progress is critical to making change. You focus on the execution of your content while balancing a fast-paced environment and you take the time to celebrate both the small & big wins. 
• INCLUSION is a core tenant of your personal beliefs. A diverse and inclusive environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
• You have the GRIT, drive and ambition to tackle big problems. Big problems require big ideas and a team that supports new ideas. 
• You care deeply for your customers are driven to keep HUMANITY in all decisions. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
• Integrity guides you in life. Focusing on the TRUTH vs. giving people the answers they want to hear. 
• You thrive in a Team Environment. Collaboration is key in innovation and creating change.

These pillars of LIGHT are a reminder to our team that we are making a difference by providing guidance and support in navigating the often complex and confusing landscape of healthcare. We hope that through this LIGHT, individuals can find their way to the best care, resources, and support they need to get back to life. 

If this sounds like you, we would love to connect to speak further about career opportunities at Lantern.

Please apply to our role & someone from our Talent Acquisition Team will reach out to help you navigate our interview process.

Overview

Our Reimbursement Specialists are a central points of contact for our provider network. The primary responsibility of the role is to deliver effective, accurate payment and communication to our providers. The day-to-day responsibilities of our Reimbursement Specialists include payment processing, researching, accurate billing/payment disbursement, and ensuring payment data accuracy and integrity. The desired candidate is articulate, empathetic, pragmatic, self-starting and ambitious. In addition, our Reimbursement Specialists are horizontal thinkers, analytical, organized and detail oriented.

Key Responsibilities:

• Processes provider payments in accordance with company policies and procedures.
• Serves as primary contact to Finance Department regarding payment, determinations and payment processing activities.
• Assist in the final determination on claim disposition and payment determination.
• Serves as liaison to internal departments regarding provider related inquiries on claims related content.
• Processes adjustments or provider disputes providing timely follow-up.
• Coordinates research and responds to system inquiries from providers regarding payment, reimbursement determination, provider contact information and claims billing procedures.
• Communicates with supervisor on a daily and/or weekly basis regarding any outstanding claims issues related to system, authorizations, reimbursement/payment errors or internal approvals.
• Works with provider contracting staff when new/modified reimbursement contracts are needed
• Performs pre-adjudication claims reviews to ensure proper terms and schedules were used.
• Initiate necessary actions regarding pending claims or payment documentation.
• Follow up on open items reports to timely and accurate resolution.
• Respond proactively to provider issues and concerns and give feedback to management.
• Provide feedback to the manager regarding proper claims billing procedures in accordance with company policy and procedures.
• Assist in training new Payment Specialists.
• Initiate change requests to resolve system issues impacting claims/payment processing or issue resolution
• Runs and analyzes daily activity reports.
• Analyze, develop and deliver claims resolutions quickly and accurately according to company policies and procedures.

Requirements:

• Minimum Bachelor's degree in healthcare, business, marketing or related field; or HS Diploma (or GED) and 4 years' applicable experience
• Minimum 2 years of experience in previous claims, health insurance or healthcare practice
• Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) preferred
• Knowledge of commonly used medical data resources preferred
• Knowledge of payor contracts and interpretation
• Knowledge of general office operations and/or experience with standard medical insurance claim forms preferred
• Strong communication (verbal, written and listening), teamwork, negotiation and organizational skills
• Ability to commit to providing a level of customer service within established standards
• Ability to provide attention to detail to ensure accuracy including mathematical calculations
• Ability to organize workload to meet deadlines and participate in department/team meetings
• Ability to analyze data and arrive at a logical conclusion
• Ability to identify issues and determine appropriate course of action for resolution
• Ability to display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone
• Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software
• Ability to work with accuracy in a fast-paced environment
• Ability to work independently and handle PHI and confidential information
• Ability to process detailed verbal and written instructions
• Individual in this position must be able to work in a traditional office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

 Benefits:

Lantern does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.