Billing & Eligibility Specialist - Nashville, United States - Lucent Health Solutions LLC

Lucent Health Solutions LLC Nashville, United States

2 weeks ago

Description

Job Title:
Eligibility and Billing Specialist

Location:
Rancho Cordova, CA (Hybrid)

ELIGIBILITY SPECIALIST

Job Summary:
The Eligibility Specialist is a key part of the department's successful operation.

The specialist is in daily contact with members, clients, and providers, and therefore needs to be a cheerful, competent and compassionate representative of NAA (a Lucent Health company).

The position is responsible to assess, interpret and process incoming eligibility feeds through all possible correspondence venues.

This includes but is not limited to Cobra requests, Eligibility File Audits, Individual paper eligibility forms and all other potential eligibility inquiries and forms.

Attendance can also directly impact the satisfaction level of our clients and retention of our accounts.

Essential Duties and Responsibilities:
include the following. Other duties may be assigned.

Maintains all processes to stay compliant with NAA's contractual obligations.
Meets or exceeds all departmental metrics in regard to turnaround time, accuracy, and production.
Reviews Coordination of Benefits information to ensure proper reprocessing of claims.
Coordinates and reviews incoming file loads under the Manager's direction.
Maintains Flex Spending accounts.

Processes all incoming eligibility/change/termination notices within 48 hours of receipt in accordance with the clients Plan Document and within NAA procedures including but not limited to COBRA applications/Updates, Retroactive Terminations, and individual add.

Responds to incoming inquiries within 24-48 Hours.
Links Eligibility Document Information in LuminX.
Processes any and all potential vendor eligibility issues.
Communicates daily with the Manager regarding workload and potential delays.
Notifies participant/client of any missing data.

Informs the Manager of any disputes, which may arise with a client, and any communication from an attorney or government agency.

Coordinates billing processes with the Finance department to ensure timely and accurate billing.

Advises the Manager of any computer problems in the claims processing software including any error message or the failure of the system to correctly process eligibility.

Proactively seeks growth through the skill matrix and all available resources.
Processes incoming eligibility requests in a timely fashion with 98% or better accuracy.
Assists as needed or directed with other departments on an as needed basis.
Participates as a Team Member to ensure the smooth operation of the entire department.
Complies with company policies and procedures.
Complies with department policies and procedures.
May assist in training other employees at management's request.
Performs special projects at the request of the Manager.
Answers all correspondence promptly and maintains correspondence files.
Regular, predictable attendance is required.
Ability to get along and work effectively with others.

Supervisory Responsibilities:
This position has no supervisory responsibilities.

Measures of Performance:
The Eligibility Specialist shall be performing in an acceptable manner when the following have been accomplished:

Problem Solving – Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

Customer Service – Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.

Interpersonal Skills – Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Tailors the content of speech to the level and experience of the audience; Uses appropriate grammar and choice of words in oral speech; Organizes ideas clearly in oral speech; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Attention to Communication – Ensures that others involved in a project or effort are kept informed about developments and plans; Ensures that important information from his/her management is shared with his/her employees and others as appropriate; Shares ideas and information with others who might find them useful; Uses multiple channels or means to communicate important messages (e.g. memos, newsletters, meetings).

Teamwork – Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Listens and responds constructively to other team members' ideas; Offers support for others' ideas and proposals; Is open with other team members about his/her concerns; Expresses disagreement constructively.

Ethics – Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

Organizational Support – Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.

Judgment – Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.

Planning/Organizing – Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

Professionalism – Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Quality – Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Attendance/Punctuality – Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:
High School Diploma or equivalent.

One to two years related experience and/or relevant training in a business office environment; or, equivalent combination of education and experience.

Language Skills:
Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports, and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Mathematical Skills:
Ability to calculate figures and amounts such as discounts, interest, commissions and percentages. Ability to apply concepts of basic algebra and geometry.

Reasoning Ability:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Internet software and the Microsoft Office Suite of products, LuminX eligibility programs and PBM software.

Knowledge of basic office equipment should include:
Internet and email, copy and fax machines, postage meter and telephone.

Physical and Emotional Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The inability to cope with a stressful work environment does not constitute a protected disability.

While performing the duties of this job, the employee is frequently required to sit.

The employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, and talk or hear.

The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.

Work Environment:

The work environment characteristics described here are representative of those an employee encounter while performing the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually quiet.

Pay range:
$19/hr - $19.95/hr

An Equal Opportunity Employer
Lucent Health Solutions consider applicants on the basis of qualifications and without regard to race, color, religion, sex, national origin, age, marital or veteran status, sexual orientation, disability or any other legal

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