Provider Claims Intake 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

The Provider Claims Intake Specialist supports the billing and claims department of Lantern by overseeing the data entry process to maintain accurate and up-to-date records and contracts. This role plays a crucial part in collecting and processing claims data, collaborating with healthcare providers, and ensuring prompt and precise payment processing. The ideal candidate will establish trust and rapport with Lantern’s provider administrative counterparts through proactive communication, exceptional customer service, problem-solving abilities, and a consultative approach. Successful Provider Claims Intake Specialist are characterized by their organization, interpersonal skills, resourcefulness, and ability to work independently.

Responsibilities:

• Validate claims across various levels of complexity, including managing duplicates, manual entries, refunds, appeals, and rejections.
• Process implant invoices through manual entry when necessary, ensuring all details are recorded correctly.
• Manage the submission and validation of Member Termination claims via ticketing systems, ensuring proper documentation and resolution.
• Conduct comprehensive audits, including Service Creation Audits, Surgery/Testing Audits, Reject Audits, Refund Audits, and Manual Entry Audits; lead provider claim education initiatives, and oversee special projects and deferred SLA monitoring.
• Exhibit strong communication skills and provide educational support to team members; handle Tier 1 escalations and adjudication reviews; contribute to team audits and performance evaluations.
• Act as a Subject Matter Expert (SME) for complex claims, oversee Claim Submission inbox management, coordinate intake assignments, and manage manual entries and correspondence files.
• Lead and manage special projects, including the handling of repriced Waystar claims, while ensuring compliance with service level agreements (SLAs).
• Collaborate effectively within a team environment, while also demonstrating the ability to work independently and manage tasks autonomously.
• Perform additional duties as assigned, contributing to the overall efficiency and effectiveness of the claims processing team

 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.