Lumeris

Medical Services Representative

Source: Lensa

In order to apply for a position at Lumeris, you must create an account using your email address and a password of your choosing. This account will allow you to receive notifications each step of the way through the job application process. With these updates, you'll never have to wonder where you are in the process. Additionally, we can easily send pertinent documents to you for your review. Once you create the account, you may apply to any position you feel is a good fit without having to re-enter information. Thank you for your interest in Lumeris. Position: Medical Services Representative Position Summary: This position supports the Medical Management Department, which acts as a resource to all Essence providers and their patients. The MSR administers daily coverage requests for health care services including ambulance transport, inpatient hospitalization, skilled nursing care, home nursing services, durable medical equipment, outpatient procedures and pharmaceuticals. Coverage requests are made via phone and fax. The MSR also assists in processing pended claims, supports clinical staff and performs administrative tasks as required by the Centers for Medicare and Medicaid Services (CMS). Job Description: Role and Responsibilities: * Receive preauthorization and referral requests via provider calls or faxes * Conduct initial benefit coverage and medical necessity clinical screening using Medicare and plan-defined guidelines in coordination with a pre-certification nurse * Enter referrals and authorizations into Facets and provide confirmation of entry back to requesting provider * Assist in the processing of medical claims that pend for medical management review * Document inpatient notifications from facilities and report them to plan and network provider case managers * Perform data entry to support the processing of Health Risk Appraisals (HRAs) * Support the verification process for the diabetes Special Needs Plan (SNP) * Adhere to regulatory and departmental timeframes for review of requests received * Maintain HIPAA standards and ensure confidentiality of protected health information * Ensure compliance with all state and federal regulations and guidelines in day-to-day activities * Perform special projects as assigned. Experience, Qualifications and Education: * High-school degree (GED or equivalent) * Experience using Microsoft Office * Previous Insurance/Pre-Service exp preferred * Prior managed care experience preferred * Call center experience preferred * Medical Terminology a plus Additional knowledge, skills, and ability required: * Excellent verbal and written communication skills * Excellent customer service skills * Professional demeanor and the ability to work effectively within a team or independently * Having a positive attitude and using proper phone etiquette * Strong decision making skills * Strong organizational skills * Ability to multi-task * Desire to work in a diverse and fast-paced environment * Experience with Facets is a plus Lumeris is an EEO/AA employer M/F/V/D. Location: St. Louis, MO Time Type: Full time

5 minutes ago

St louis, Mo

Lumeris

Full Time

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