Lumeris Provider Data Analyst in St. Louis, Missouri

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Position:

Provider Data Analyst

Position Summary:

At Lumeris you will be part of team that is focused on solving a national healthcare problem. And you will have the ability to contribute while working for a purpose. Our environment is fast-paced and change oriented and is focused on growth and employee engagement. At Lumeris we believe talent is utilized best when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.

Job Description:

Role and Responsibilities:

  • Optimize and maintain Provider Data monitoring program to ensure data input is compliant with Federal, State and Local laws and regulations

  • Perform monthly monitoring of provider directories

  • Analyze data to identify trends in errors, pended claims, and data changes in order to gain efficiencies

  • Perform root cause analysis on error trends and work with internal and external stakeholders to resolve the root issue

  • Perform quality service checks on provider data inclusive of claims processing and provider directory information

  • Provide reporting and analysis of data to the Provider Data Leadership team as necessary

  • Perform testing on Facets and other systems to ensure functionality after releases and version upgrades

  • Serve as the primary escalation point for issues raised by the Provider Data Specialists

  • Perform research and resolve provider data issues

  • Loading of provider demographic data either through manual or automated process of provider records into provider data management system for provider directory and claims payment purposes as necessary

  • Loading of non-participating provider demographic data from either paper or electronic claims for claims payment purposes as necessary

  • Research, review and make updates within the provider data management system per provider requests

Experience, Qualifications and Education:

  • Bachelor’s degree or equivalent experience in Business, Healthcare or other related field required

  • Demonstrated experience solving complex or ambiguous problems

  • Demonstrated experience researching and understanding complex information such as government regulations, contracts, etc

  • Demonstrated experience using data to identify trends and guide business actions

  • Ability to work independently in a fast-paced environment with competing priorities

  • Demonstrated ability to communicate effectively through both written and verbal modalities

  • Proficiency with business applications like the Microsoft Office Suite

  • Experience with Facets, SharePoint and Knowledge Lake a plus

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

Location:

St. Louis, MO

Time Type:

Full time

Status:

XL - FT

Join Our Growing Team!

Lumeris serves as a long-term operating partner for organizations that are committed to the transition from volume- to value-based care and delivering extraordinary clinical and financial outcomes. Lumeris enables clients to profitably achieve greater results through proven playbooks based on collaboration, transparent data and innovative engagement methodologies. Lumeris offers comprehensive services for managing all types of populations, including launching new Medicare Advantage Health Plans, Commercial and Government Health Plan Optimization, and Multi-Payer, Multi-Population Health Services Organizations (PHSOs). Currently, Lumeris is engaged with health systems, provider alliances and payers representing tens of millions of lives moving to value-based care.

Over the past seven years, we have tripled in size to more than 800 employees and built the only solution on the market with our proven outcomes. For the past six years, Essence Healthcare, a long-standing Lumeris client, has received 4.5 Stars or higher from the Centers for Medicare and Medicaid Services (CMS). Essence Healthcare was Lumeris’ pioneer client and has been leveraging Lumeris for more than a decade to operate its Medicare Advantage plans, which serve more than 60,000 Medicare beneficiaries in various counties throughout Missouri and southern Illinois.

In 2018, Lumeris was named Best in KLAS for Value-Based Care Managed Services in the area of client-reported impact on the Triple Aim by KLAS Research. This was the third year in a row Lumeris received the award, and it has only been given for three years. As the industry’s most reliable and effective partner for developing population health management solutions, our success is driving tremendous growth in our company. Join us today in making a real difference in how healthcare is delivered!

Why Join Lumeris?

At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.