Abrar Admin

Lucent Health Solutions

<div>Hybrid schedule: Nashville TN
About Lucent Health
Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.
Company Culture
We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health.
Honest<ul><li>
Transparent Communication: be open and clear in all interactions without withholding crucial information</li><li>
Integrity: ensure accuracy in reporting, work outputs and any tasks assigned</li><li>
Truthfulness: provide honest feedback and report any issues or challenges as they arise</li><li>
Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior</li></ul>
Ethical<ul><li>
Fair Decision Making: ensure all actions and decisions respect company policies and values</li><li>
Accountability: own up to mistakes and take responsibility for rectifying them</li><li>
Respect: treat colleagues, clients and partners with fairness and dignity</li><li>
Confidentiality: safeguard sensitive information and avoid conflicts of interest</li></ul>
Hardworking<ul><li>
Consistency: meet or exceed deadlines, maintaining high productivity levels</li><li>
Proactiveness: take initiative to tackle challenges without waiting to be asked</li><li>
Willingness: voluntarily offer to assist in additional projects or tasks when needed</li><li>
Adaptability: work efficiently under pressure or in changing environments</li></ul>
Summary:
The Claims Appeals Specialist is responsible for reviewing, analyzing and processing claims for pre services and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non-clinical services, quality of service and quality of care issues to include executive and regulatory grievances. The Appeals Coordinator is in daily contact with team members, clients and providers. A cheerful, competent, and compassionate attitude will directly impact the productivity of the team. Attendance can also directly impact on the satisfaction level of our clients and retention of our accounts.
Responsibilities:<ul><li>
Reviews, analyzes, and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable language.</li><li>
Utilizes guidelines and review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route leadership for review.</li><li>
The grievance and appeal work are subject to applicable accreditation and regulatory standards and requirements. As such, the coordinator will strictly follow department guidelines and tools to conduct their reviews.</li><li>
Analyzes and renders determinations on assigned non-complex grievance and appeal issues and completion of the respective written communication documents to convey the determination.</li><li>
Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.  Interpret Plan Documents and review appeals within guidelines and timeframes as determined by the clients plan coverage.</li><li>
Maintain and or develop workflows with comprehensive notes with attention to detail to enable accurate claims processing related to appeals and or refunds.</li><li>
Maintain quality and production standard when processing appeals and client refunds.</li><li>
Exhibit an attention to detail and a strong work ethic.</li></ul>
Qualifications:<ul><li>
Previous Claim processing experience is required</li><li>
Thorough knowledge of coding structures (CPT, HCPCS, Revenue codes, ICD 9/10 etc.)</li><li>
Experience with COB payments and distribution of funds</li><li>
Ability to understand all types of claims pricing (Network, Medicare, UCR etc.)</li></ul> 
Equal Employment Opportunity Policy Statement
Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.</div>

Claims Appeals Specialist- Hybrid- Nashville TN

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Lucent Health Solutions

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Claims Appeals Specialist- Hybrid- Nashville TN