Client Operations Success Specialist
4 weeks ago
Lucent Health Solutions, Inc. is seeking a highly skilled Client Operational Success Specialist to join our team. This role is crucial in enhancing operational success and client satisfaction.
The ideal candidate will have strong expertise in both Eligibility and Claims Functions, with excellent communication skills and the ability to work effectively within a team environment.
Key Responsibilities:
- Implementation Support: Guide new group implementations and support system configuration & testing prior to transitioning accounts to the Client Services team.
- Client Day-to-Day Support: Deliver exceptional support related to billing, eligibility & claim inquiries, ensuring timely and accurate responses to client needs.
- Issue Resolution Management: Investigate and resolve escalated billing, eligibility & claim questions within a target turnaround of 3-5 days.
- Claims Processing Knowledge: Utilize strong knowledge of claims processing, including high dollar claims, TPL issues, vendor disputes, and potential stop loss matters, to assist in issue resolution.
- Reporting and Data Entry: Enter billing, eligibility & claims information, monitor workflow, and provide status reports on processing progress.
- Communication with Internal Teams: Collaborate closely with Senior Claims Analysts, Client Services, and Customer Service to ensure proper handling and communication regarding claim & eligibility issues.
- Audit and Quality Control: Oversee processing quality reviews, conduct audits, and provide feedback on accuracy.
- Training and Support: Assist in training staff on processes and best practices, fostering a clear understanding of requirements and documentation associated with dedicated accounts.
Qualifications:
- Eligibility Expertise: Strong understanding of eligibility requirements, documentation, and related regulations.
- Claims Expertise: In-depth knowledge of claims processing, coding structures (CPT, HCPCS, ICD-9/10), and claims pricing methodologies (Network, Medicare, RBP, UCR).
- Excellent Communication Skills: Ability to effectively communicate complex information to clients and colleagues.
- Organizational Skills: Demonstrated ability to maintain accurate records and manage time efficiently.
- Team Collaboration: Ability to work effectively within a team environment and provide training support to colleagues.
Working Conditions:
- Regular, predictable attendance is required.
- Ability to collaborate effectively with colleagues across both eligibility and claims functions.
Lucent Health Solutions, Inc. 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.
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