Soma Capital Portfolio Jobs

Plan Benefit System Analyst

Curative

Curative

IT
Texas, USA · Remote
Posted on Tuesday, June 11, 2024

Curative is searching for an experienced Health Plan System Benefit Analyst. This position
successfully manages the day-to-day activities of the Claims & System Configuration Team.
Performs all duties below while maintaining compliance and confidentiality
and promoting the mission and philosophy of the organization.

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, 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 and projects assigned.

MINIMUM QUALIFICATIONS:

Education:
● High school diploma or equivalent. Associate degree preferred or equivalent experience

Experience:
● At least 3-5 years of Health Care Claims Processing and Health Plan Configuration experience required,including HMO, PPO, ERISA, and government plans experience.
● Preferred Experience working with Health Edge- Health Rules Payer system, a variety of claims payment systems, processing of all claim types, to include hospital/facility, behavioral health, dental, vision, and professional medical claims. Experience working with the VBA claims system.

Knowledge, Skills, and Abilities:
● Ability to communicate with all levels of staff.
● Advanced Knowledge of claim coding and editing rules
● 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.
● Excellent verbal and written communication skills
● Ability to communicate clearly and effectively.
● Ability to sit for extended periods of time at a computer workstation.

PHYSICAL DEMANDS:
SEDENTARY (requires lifting to 10 lbs., carrying small objects)