What are the responsibilities and job description for the Vice President, Claims and Provider Services position at employerdirecthealthcare?
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.
Vice President, Claims and Provider Services
The Vice President of Claims and Provider Services will oversee and lead daily claims operations, provider support services, and revenue cycle management while driving development and implementation of best practices. This role demands a practical, hands-on leader who can drive efficiency, ensure compliance, and foster strong relationships with providers while optimizing our operational efficiency. The ideal candidate will have a proven track record in claims management and a deep understanding of the health insurance landscape, as well as strong analytical skills and a proven ability to build and lead high-performing teams in a fast-paced, growth-oriented environment.
Key Responsibilities:
- Claims Processing: Lead and manage the claims processing function to ensure timely, accurate, and efficient handling of all claims. Develop and implement policies and procedures to streamline operations and enhance the customer experience.
- Provider Support: Lead and manage the provider support function to ensure timely and accurate responses to inquiries, timely and effective provider onboarding, and continued development of our dedicated support team. Develop and implement strategies to support provider engagement, address concerns, and ensure smooth interactions between providers and the company.
- Revenue Cycle Management: Oversee revenue cycle processes for provider payments, claims receipt, member invoicing and collections. Analyze and improve revenue cycle performance, including billing, collections, and accounts receivable management.
- Strategic Leadership: Provide strategic direction and leadership to the claims department. Develop and execute short-term and long-term goals that align with the company’s overall business strategy.
- Compliance & Risk Management: Ensure compliance with regulatory requirements, industry standards, and internal policies. Identify and mitigate risks associated with claims processing and revenue cycle management.
- Team Development: Build, mentor, and lead a high-performing team of exempt and non-exempt workforce. Foster a culture of continuous improvement, professional development, and accountability.
- Data Analysis & Reporting: Utilize data and analytics to drive decision-making and performance improvements. Prepare and present reports to executive leadership on key metrics and strategic initiatives.
Qualifications:
- Bachelor’s degree in Business Administration, Health Administration, Finance, or a related field. Advanced degree (MBA, MHA) preferred.
- Minimum of 10 years of experience in claims management, with at least 5 years in a senior leadership role.
- Experience in the health insurance industry.
- Strong leadership and management skills with a proven ability to drive organizational change.
- In-depth knowledge of healthcare claims processing, managed care network management, and revenue cycle management.
- Medicare billing experience strongly preferred, or knowledge of Medicare billing rules
- Excellent analytical, problem-solving, and decision-making skills.
- Ability to communicate effectively with internal and external stakeholders.
- Experience with Zelis-PayerCompass or similar tools (e.g. Plexis, Datagenix)
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.
