Lumeris Supervisor, Appeals in St. Louis, Missouri

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Position:

Supervisor, Appeals

Position Summary:

This position is responsible for the overall management of all appeals processing and associated tasks to ensure compliance to the Centers for Medicare and Medicaid Services (CMS) appeals processing timeliness standards while maintaining high quality. The position provides assistance with monitoring, reporting and CMS audits. In addition, this position is responsible for monitoring staff performance against Company standards, coaching and conducting performance reviews, training new staff, updating training documents, departmental policies and operating procedures, daily management of the appeals workload, and maintaining open communication throughout the day with on-site and remote team members. This position will have a small workload of cases and will fill in as needed to work cases. On-call tasks may include answering questions, assisting with information gathering, and reviewing letters.

Job Description:

Role and Responsibilities

  • Monitor all staff needs, including training requirements, quality and production

  • Responsible for day-to-day operations and management of the appeal processing team in accordance with administrative and departmental policies and procedures

  • Identify untimely cases, system issues and process improvement opportunities and implement changes to improve efficiency

  • Lead case status meetings and assist with decision making

  • Assist with CMS audits and client interactions

  • Confirm compliance of all appeals, assist with communication to clients, and work closely with the appeals monitor to identify trends

  • Provide counsel on performance issues

  • Become familiar with appeal reports and coordinate ways to use the reports to improve outcomes in the department

  • Hold staff one-on-ones, quarterly BetterWorks conversations, yearly performance reviews, and oversight of the teams BetterWorks goals

  • Manage the workload to ensure timeliness and quality measures are met

  • Perform special projects as needed

Experience, Qualifications and Education

  • High School diploma or equivalent, with Bachelor’s degree strongly preferred

  • 4-6 years of related healthcare experience, including some leadership experience and preferably Medicare experience especially with Federal Regulations

  • Demonstrated progressive leadership experience

  • Excellent interpersonal, oral and written communication

  • Strong problem solving and issue resolution skills

  • Ability to work with cross-functional teams

  • Ability to effectively present information to the team, cross functioning departments, clients and upper management

  • Ability to lead and manage others

  • Ability to work independently, handle multiple assignments, establish priorities, and demonstrate high level time management skills

  • Proficiency in Microsoft Office including Outlook, Word, Excel, Notebook and PowerPoint

  • Knowledge of proprietary systems (eg. Facets, JIVA)

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.