Billing & Eligibility Specialist- Rancho Cordova CA at Lucent Health

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 

• Transparent Communication: be open and clear in all interactions without withholding crucial information
• Integrity: ensure accuracy in reporting, work outputs and any tasks assigned
• Truthfulness: provide honest feedback and report any issues or challenges as they arise
• Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior

Ethical 

• Fair Decision Making: ensure all actions and decisions respect company policies and values
• Accountability: own up to mistakes and take responsibility for rectifying them
• Respect: treat colleagues, clients and partners with fairness and dignity
• Confidentiality: safeguard sensitive information and avoid conflicts of interest

Hardworking 

• Consistency: meet or exceed deadlines, maintaining high productivity levels
• Proactiveness: take initiative to tackle challenges without waiting to be asked 
• Willingness: voluntarily offer to assist in additional projects or tasks when needed
• Adaptability: work efficiently under pressure or in changing environments

Summary: 

The Billing/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.

Responsibilities

· 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.

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.

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.