Data entry analyst

SUMMARY Curative wants to change the view on what a health plan can be. Born out of the pandemic, we created a health plan reinvented for a post-pandemic world that is built around a whole person’s affordable preventive care featuring more benefits. Curative is looking for a Data Analyst with Medical claims processing expertise, who is passionate about helping the company as we work to reinvent healthcare options. Candidates will be able to utilize their previous experience in the medical field by increasing satisfaction and retention by providing Curative health plan members, patients, and providers with accurate, consistent, timely information. They will provide support while building rapport and collaborative relationships with current and prospective members in accordance with compliance guidelines. This is a remote position.

ESSENTIAL DUTIES AND FUNCTIONS

• Successfully Delivers the day-to-day operations of the Curative System Configuration Team activities.
• Consistently ensure the tasks for System Configuration teams are performed and completed & communicated to the other team members.
• Work closely with IT, Medical Services, Claims Team, System Support, to ensure efficiency.
• Reviews of PENDED claims on a daily basis for various reasons to ensure claims are processed timely.
• Works with the Claims Processing department to ensure day to day PENDS are being handled in a timely manner.
• A team player and being able to perform tasks in a very fast paced environment.
• Analyzes, tracks and trends provider, system setup and claim errors.
• Works on claims team projects and reporting, assigned.
• Assists with all groups for professional and facility claim processing.
• Attend departmental training when required or requested.
• Adheres to the rules and regulations of Curative as described in the Employee Handbook and as defined in the unit/department/clinic procedures
• Performs other duties as assigned

EXPERIENCE

• At least 3-5 years of experience in claims adjudication, including PPO and/or Medicaid, ERISA, Medicare, Level Funded and Self-Funded Experience with various claim payment systems in processing hospital, mental health, dental and routine medical claims within given deadlines.
• Excellent Working Knowledge of MS Access, Google Sheets and Excel required
• Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding.
• Experience processing claims on the HealthEdge System is preferred
• Excellent computer and keyboarding skills, including familiarity with Windows
• Excellent interpersonal & problem-solving skills.
• Excellent verbal and written communication skills to communicate clearly and effectively with all levels of staff, members, and providers.
• Ability to be focused and sit for extended periods of time at a computer workstation.
• Ability to work in a team environment and manage competing priorities
• Ability to calculate allowable amounts such as discounts, interest, and percentages

Knowledge, Skills, and Abilities

• Ability to communicate with all levels of staff.
• Advanced Knowledge of claim coding and editing rules Optum/CMS
• Knowledge of TDI regulations and requirements for claims payments
• Knowledge of HIPPA regulations
• Knowledge of medical terminology, ICD-10 CPT, and HCPCS coding.
• Proficient computer skills to include Microsoft Office applications and Google Sheet
• Excellent verbal and written communication skills
• Ability to communicate clearly and effectively.
• Ability to sit for extended periods of time at a computer workstation.
• Performs other duties and projects assigned.
• Ability to Multitask and think creatively.
• Enrollment/ Eligibility 834’s knowledge
• Claims 837 Files knowledge
• Cobra Knowledge/COB Knowledge