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Claims Reimbursement Specialist

Dallas, Texas, United States

About Lantern

Lantern is the specialty care platform connecting people with the best care when they need it most. By curating a Network of Excellence comprised of the nation's top specialists for surgery, cancer care, infusions and more, Lantern delivers excellent care with significant cost savings to employers and their workforces. Lantern also pairs members with a dedicated care team, including Care Advocates and nurses, for the entirety of their care journey, helping them get back to good health, back to their families and back to work. With convenient access to specialists nationwide, Lantern means quality care is within driving distance for most. Lantern is trusted by the nation's largest employers to deliver care to more than 6 million members across the country. Learn more about us at lanterncare.com. 

About You:

  • You use LOGIC in your decision making and understand that progress is critical to making change. You focus on the execution of your content while balancing a fast-paced environment and you take the time to celebrate both the small & big wins. 
  • INCLUSION is a core tenant of your personal beliefs. A diverse and inclusive environment is incredibly important to you. You understand and desire to be a part of a diverse team with different experiences and perspectives & you cherish the differences in each individual that you interact with.
  • You have the GRIT, drive and ambition to tackle big problems. Big problems require big ideas and a team that supports new ideas. 
  • You care deeply for your customers are driven to keep HUMANITY in all decisions. Your customers aren’t just the individuals using your product. They are the driving factor in your motivation to make a change.
  • Integrity guides you in life. Focusing on the TRUTH vs. giving people the answers they want to hear. 
  • You thrive in a Team Environment. Collaboration is key in innovation and creating change.

These pillars of LIGHT are a reminder to our team that we are making a difference by providing guidance and support in navigating the often complex and confusing landscape of healthcare. We hope that through this LIGHT, individuals can find their way to the best care, resources, and support they need to get back to life. 

 

If this sounds like you, we would love to connect to speak further about career opportunities at Lantern.

Please apply to our role & someone from our Talent Acquisition Team will reach out to help you navigate our interview process.

 

Claims Reimbursement Specialist

Are you someone who thrives on precision and enjoys diving into the details? We are looking for a dedicated and highly organized Claims Reimbursement Specialist to join our Claims team. In this role, you will be responsible for reviewing, pricing, and reimbursing medical claims according to our provider contract provisions. This is a critical function in ensuring our providers are compensated for the services they deliver. Accuracy, attention to detail, and timely service are the foundation of our provider experience, and critical to Lantern’s success.  Your work will directly impact the quality of our Network Providers’ experience and contribute to our growth. 

All Claims Reimbursement Specialist schedules are Monday-Friday.

  • 7:00AM-4:00PM
  • 8:00AM-5:00PM
  • 8:30AM-5:30PM

Location: Dallas, TX - 100% Onsite 


Key Responsibilities: 

  • Claims Review and Pricing Calculation: Review medical claims for compliance with billing guidelines. Utilize claims tools to calculate contracted reimbursement amounts based on process guidelines and contract details, ensuring the highest level of accuracy. 
  • Contract Analysis: Review provider contracts to understand reimbursement structures, fee schedules, and any other relevant contractual terms to ensure proper payment calculations. 
  • Data Entry & Documentation: Maintain clear and accurate records of all claims, contract reviews, and pricing calculations for audit purposes and internal tracking. 
  • Problem Resolution: Address discrepancies or questions related to reimbursement and pricing by collaborating with internal teams and providers, ensuring timely resolution. 
  • Process Improvement: Identify any recurring issues in claims and pricing processes and work with the team to suggest improvements that can streamline workflows and enhance accuracy. 

Required Skills and Qualifications: 

  • Bachelor’s degree preferred, preferably in Healthcare Administration or a related field 
  • 3 - 5 years of experience in claims processing or medical claims billing 
  • Exceptional attention to detail and a high level of accuracy in all aspects of work 
  • Strong analytical skills and ability to work with complex data and pricing structures. 
  • Proficient in Microsoft Office Suite and familiarity with medical claims management software 
  • Excellent time management skills, with the ability to prioritize tasks effectively  
  • Exceptional communication skills (both written and verbal), with the ability to explain complex information in a clear, concise, and friendly manner 

Preferred Qualifications: 

  • Experience in medical claims billing and familiarity with Medicare claims reimbursement pricing 
  • Certification in medical claims coding, e.g. Certified Medical Reimbursement Specialist (CMRS), Certified Medical Billing and Coding Specialist (CMBCS) 

 Benefits

  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • Short & Long Term Disability
  • Life Insurance
  • 401k with company match
  • Paid Time Off
  • Paid Parental Leave

 

Lantern does not discriminate on the basis of race, sex, color, religion, age, national origin, marital status, disability, veteran status, genetic information, sexual orientation, gender identity or any other reason prohibited by law in provision of employment opportunities and benefits.

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