About Lucent Health
Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.
Company Culture
We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health.
Honest
- Transparent Communication: be open and clear in all interactions without withholding crucial information
- Integrity: ensure accuracy in reporting, work outputs and any tasks assigned
- Truthfulness: provide honest feedback and report any issues or challenges as they arise
- Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior
Ethical
- Fair Decision Making: ensure all actions and decisions respect company policies and values
- Accountability: own up to mistakes and take responsibility for rectifying them
- Respect: treat colleagues, clients and partners with fairness and dignity
- Confidentiality: safeguard sensitive information and avoid conflicts of interest
Hardworking
- Consistency: meet or exceed deadlines, maintaining high productivity levels
- Proactiveness: take initiative to tackle challenges without waiting to be asked
- Willingness: voluntarily offer to assist in additional projects or tasks when needed
- Adaptability: work efficiently under pressure or in changing environments
Summary:
An Appeals Nurse is responsible for managing and processing appeals related to denied or underpaid insurance claims. This role involves reviewing medical records, analyzing clinical information, and preparing written appeals to ensure that patients receive the necessary coverage for their treatments.
Responsibilities:
- Review Medical Records: Examine patient medical records and claims to determine the necessity and appropriateness of treatments provided.
- Prepare Appeals: Write and submit detailed appeals to insurance companies, outlining the medical necessity and appropriateness of the treatments.
- Collaborate with Healthcare Providers: Work closely with physicians, case managers, and coders to gather all necessary information for appeals.
- Stay Informed: Keep up-to-date with regulatory guidelines and criteria related to medical necessity and insurance coverage.
- Communicate Effectively: Liaise with patients, family members, healthcare providers, and insurance companies regarding the status of appeals.
- Document Actions: Maintain accurate records of all actions and outcomes related to appeal efforts.
- Develop Policies: Assist in creating and updating policies and procedures for the appeals process.
Qualifications:
- Education: Bachelor’s degree in Nursing (BSN) or an Associate’s degree in Nursing (ADN) with relevant experience.
- Licensure: Active Registered Nurse (RN) license.
- Experience: Previous experience in a clinical nursing role, preferably with experience in case management or utilization review.
- Skills: Strong written and verbal communication skills, detail-oriented, analytical, and proficient in medical coding and electronic medical records software.
Equal Employment Opportunity Policy Statement
Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.