Your Future is our Future

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

Position:

Position Summary:

Job Description:

Primary Responsibilities

• Reviews, evaluates, documents, and tracks appeal documents.  Follows request through resolution by established processes and procedures, and within established time standards.
• Creates, composes, and provides quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals request within established time standards.
• Helps identify areas of improvement for self and the department.
• Prepares case files for Independent Review Entities or other levels of the Appeals process.
• Communicates with members and providers on appeal resolution.
• Performs peer QA of appeal notification letters.
• Ensures compliance with all state and federal regulations (Center for Medicare and Medicaid Services, National Committee for Quality Assurance) and guidelines with day to day activities.

Qualifications

• High School or equivalent
• 1 + years Appeals related experience or the knowledge, skill, abilities to succeed in the role
• Strong learning agility and enthusiastic about developing new skills
• Ability to interact professionally and maintain confidentiality and high ethical standards
• Ability to multi-task, meet deadlines, and adapt to changing priorities
• Solid oral and written communication skills
• Good computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook
• Solid attention to detail

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions
• Work weekends and company holidays as needed based on business regulatory requirements

#LI-Remote

Pay Transparency:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.

The hiring range for this position is:

Benefits of working at Lumeris

• Medical, Vision and Dental Plans

• Tax-Advantage Savings Accounts (FSA & HSA)

• Life Insurance and Disability Insurance

• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)

• Employee Assistance Program

• 401k with company match

• Employee Resource Groups

• Employee Discount Program

• Learning and Development Opportunities

• And much more...

Be part of a team that is changing healthcare!

Member Facing Position:

Location:

Time Type:

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Disclaimer:

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.