Lab Claims Operations Specialist (Remote)

eviCore healthcare - Remote3.2

The candidate will be a member of the Lab Management Program and will be responsible for designing, implementing, and monitoring a claims processing product that remains in alignment with rapidly shifting commercial, Medicare, and Medicaid medical policy. This requires a working knowledge of procedure coding, diagnosis coding, claims data elements, and claims system capabilities. Experience in a clinical laboratory setting is critical with at least five years’ experience. Major responsibilities include: Work with medical policy team to understand the policy goals and ensure appropriate associated coding and claims processing language; work with analytics to model policy-based claims processing to ensure the expected outcomes in historical claims data; Coordinate claims configuration design, implementation, maintenance, customization, and documentation; Act as subject matter expert for claims disputes; Monitor claims product performance, including accurate processing, value metrics, trends, unusual billing patterns, and opportunities for enhancement; and Manage projects to continuously improve the claims processing product.

Minimum Experience Required
Bachelor's degree or equivalent work experience. Billing certification preferred. 5+ years’ experience in a clinical laboratory setting.

Required Skills
Solid understanding of claims data and processing systems
Demonstrated experience using medical coding systems and databases
Analytical, problem-solving nature with ability to work with data and reporting tools to research, organize, and summarize findings (Excel knowlege)
Detail-oriented with the strong organizational skills required to track thousands of claims policies
Self-motivated with ability to define projects, prioritize responsibilities in a fluid environment, and work with minimal instruction or supervision
Excellent verbal and written communication skills as well as the ability to effectively interact with all levels of staff and management
Our Company and What We Offer
eviCore healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. eviCore offers a variety of perks and benefits including, but not limited to:

Flexible scheduling and work/life balance with remote and work from home opportunities
3 weeks of PTO(starting) per year plus paid holidays
Education assistance, tuition reimbursement and professional certifications
Health, dental, vision, and life benefits with employer funded HSA
Comprehensive employee discount program, onsite fitness facilities, and smart casual dress code
Paid Volunteer Community Service Days
Ample opportunities for growth, advancement, and promotion
401k retirement plan with company match of 50% employee contributions up to 6%