Lantern · 1 day ago
Provider Claims Pricing Specialist
Dallas, TX
Full-time
Onsite
Entry, Mid Level
2+ years expLantern is a specialty care platform connecting people with top specialists for surgery and cancer care. The Provider Claims Pricing Specialist is responsible for processing provider payments, ensuring accurate billing and communication with providers, and supporting the Finance Department in payment processing activities.
Health CareHospitalMedicalMedical DeviceMental Health
Responsibilities
Processes provider payments in accordance with company policies and procedures
Serves as primary contact to Finance Department regarding payment, determinations and payment processing activities
Assist in the final determination on claim disposition and payment determination
Serves as liaison to internal departments regarding provider related inquiries on claims related content
Processes adjustments or provider disputes providing timely follow-up
Coordinates research and responds to system inquiries from providers regarding payment, reimbursement determination, provider contact information and claims billing procedures
Communicates with supervisor on a daily and/or weekly basis regarding any outstanding claims issues related to system, authorizations, reimbursement/payment errors or internal approvals
Works with provider contracting staff when new/modified reimbursement contracts are needed
Performs pre-adjudication claims reviews to ensure proper terms and schedules were used
Initiate necessary actions regarding pending claims or payment documentation
Follow up on open items reports to timely and accurate resolution
Respond proactively to provider issues and concerns and give feedback to management
Provide feedback to the manager regarding proper claims billing procedures in accordance with company policy and procedures
Assist in training new Payment Specialists
Initiate change requests to resolve system issues impacting claims/payment processing or issue resolution
Runs and analyzes daily activity reports
Analyze, develop and deliver claims resolutions quickly and accurately according to company policies and procedures
Qualification
Required
Minimum Bachelor's degree in healthcare, business, marketing or related field; or HS Diploma (or GED) and 4 years' applicable experience
Minimum 2 years of experience in previous claims, health insurance or healthcare practice
Knowledge of payor contracts and interpretation
Strong communication (verbal, written and listening), teamwork, negotiation and organizational skills
Ability to commit to providing a level of customer service within established standards
Ability to provide attention to detail to ensure accuracy including mathematical calculations
Ability to organize workload to meet deadlines and participate in department/team meetings
Ability to analyze data and arrive at a logical conclusion
Ability to identify issues and determine appropriate course of action for resolution
Ability to display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone
Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software
Ability to work with accuracy in a fast-paced environment
Ability to work independently and handle PHI and confidential information
Ability to process detailed verbal and written instructions
Individual in this position must be able to work in a traditional office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone
Preferred
Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes)
Knowledge of commonly used medical data resources
Knowledge of general office operations and/or experience with standard medical insurance claim forms
Benefits
Medical Insurance
Dental Insurance
Vision Insurance
Short & Long Term Disability
Life Insurance
401k with company match
Paid Time Off
Paid Parental Leave
Company
Lantern
Lantern is the specialty care platform connecting people with the best care when they need it most.
501-1000 employees
H1B Sponsorship
Lantern has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (12)
2024 (7)
2023 (3)
2022 (4)
2021 (3)
2020 (1)
Funding
Current Stage
Late StageTotal Funding
$93MKey Investors
Insight PartnersDundon Capital PartnersTEXO Ventures
2023-12-19Secondary Market· $92M
2020-10-27Series Unknown
2016-01-12Series C
Leadership Team
John Zutter
Chief Executive Officer
Fiona Mulligan
Chief Operating Officer
Recent News
Company data provided by crunchbase