System Configuration Analyst
System Configuration Analyst
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Job Description
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 persons affordable preventive care featuring more benefits. Curative is looking for an Enrollment Specialist 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.
Responsibilities
Successfully delivers the day-to-day operations of the Curative System Configuration Team.
Investigates and resolves configuration issues on the HealthRules Payer system to ensure timely and accurate claims payment and account implementation.
Designs implements and tests HealthRules Payer configuration to resolve issues and support the
launch of new health insurance products.Works closely with IT operational and clinical departments to ensure configuration changes in the claims platform meets business needs
Reviews and resolves claim pends on a daily basis to ensure claims are processed timely.
A team player; performs tasks in a very fast paced environment
Analyzes tracks and trends provider system setup and claim errors.
Works on claims team projects and reporting as assigned.
Attends 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.
Please reach out if this describes your experience
- 3 years of health plan configuration experience within the HealthRules Payer platform; experience with benefits configuration and/or provider contract configuration using HRL (Health Rules Language).
- 5 years of experience in claims processing of all claim types including hospital/facility behavioral health dental vision and professional medical claims.
- Operational experience in a health plan environment in or more of the following domains: enrollment/eligibility provider data management or account installation.
- Knowledge of medical terminology ICD-10 CPT HCPCS and revenue codes.
- Preferred qualification: Familiarity with claim coding and editing rules.
- Preferred qualification: experience with SQL including understanding and creating queries
- Proficient computer skills to include Microsoft Office applications and Google Sheet
- Excellent verbal and written communication skills
- Ability to sit for extended periods of time at a computer workstation.
- Ability to Multitask and think creatively.
- Performs other duties and projects assigned.
EDUCATION and/or EXPERIENCE
A Bachelors degree in computer science information technology or a related field or three to six months related experience and/or training; or equivalent combination of education and experience.
Required Experience:
IC
Employment Type
Full-Time
