Shawn Lucas Email & Phone Number

Remote

A Payment Integrity Professional will ensure the accuracy and compliance of healthcare claims. The analysis is performed for medical claims for correct coding, detecting discrepancies, preventing overpayments, and mitigating potential fraud. Payment Integrity Professionals will collaborate with healthcare providers to resolve coding issues, conduct audits, and stay abreast of industry standards. Their expertise in medical coding and billing will help maintain the integrity of our payment processes, contributing to our mission of delivering reliable and efficient healthcare services.

Louisville, Kentucky, United States

The Claims Research & Resolution Professional 2 manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Claims Research & Resolution Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.The Claims Research & Resolution Professional 2 works with insurance companies, providers, members, and collection services in the settlement of claims. Comprised of a group of calls/claims/provider associates researching the resolution to a pending call. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Remote

Medicare RIsk Adjustment as an industry seeks to predict a person's likely use and costs of healthcare across TiNs. It attempts to apply a statistical method to enable a more accurate comparison of healthcare. As a department it is up to MRA representatives both research and analyze data to collect and upload specific charts ensuring that proper analysis can take place. It should be noted that Humana's MRA is also responsible for HEDIS collections as well, where HEIS collection directly affects STAR measures supported by the NCQA. These STAR Ratings are one of the preeminent rating systems for all health care providers and should be a top goal in any Health care market be that managed care or not.

Jamestown, New York Area

NHTD & TBI Medicaid Services Coordinator. Responsible for responding to inquiries about home and community services from individuals with disabilities, their families, medical/health professionals and the general public. The Service Coordinator assists individuals who receive waiver services in gaining access to needed supports and state plan services, as well as medical, social, educational and other services regardless of funding source. Service coordinators have extensive knowledge of Home and Community Based Services in the State, and promote the Independent Living Philosophy while working with and at the direction of the participant whenever possible to identify, coordinate and facilitate waiver services of the In Home Services division. An extensive knowledge of waiver services from the Department of Health, Office of Long Term Living and Office of Aging is also used.

Bachelor Of Arts (B.A.), Psychology

Activities and Societies: Elected to Student AssemblyStudy in Psychology with an additional Concentration in Asian Studies.

Associate Of Arts - Aa, Psychology

Activities and Societies: Elected to Student Government. Vice-Chair of Facility Student Association. SUNY Model of the European Community.