Curative Health Holdings, Inc is searching for a claims analyst to review claims for completeness and process per plan guidelines. Carries out all duties while maintaining compliance and confidentiality and promoting the mission of the organization.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Reviews claims for compliance with plan guidelines and approves or denies payment using established guidelines, policy and procedures and plan directives.
Documents clearly and concisely claims adjudication decisions in Claim Notes. Consults appropriate reference materials to verify proper coding.
Ability to interpret and apply plan guidelines while processing to ensure correct plan setup.
Coordinates adjudication of claims against the eligibility of individual enrollees as well as authorizations and benefit verification.
Proactively identify processes and system problems than can be improved, to reduce rework and provide accurate payment upon original processing.
Maintains timely responses to appeals and reconsideration requests
Attends and participates in departmental training, functions, and meetings.
Ability to meet/ maintain the required accuracy and production standards after release from training.
Adheres to rules and regulations of Covenant Management Systems as described in the employee handbook and in the unit/department/clinic procedures
Performs other duties, functions and projects, as assigned, by team management.

Travel Requirements: None

REQUIRED EXPERIENCE

At least 3 years of experience in claims adjudication, including PPO and/or Medicaid. Experience with various claim payment systems in processing hospital, mental health, dental and routine medical claims within given deadlines.
Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding.
Working Knowledge of MS Access and Excel preferred
Excellent computer and keyboarding skills, including familiarity with Windows
Excellent interpersonal & problem solving skills.
Excellent verbal and written communication skills in order to communicate clearly and effectively to 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

REQUIRED EDUCATION, LICENSES and/or CERTIFICATIONS

High school diploma or equivalent.

About Us

Co-founded by CEO Fred Turner and powered by a team of world-leading doctors, scientists, engineers, and health industry experts, Curative responded in March 2020 to the urgent need for COVID-19 testing, ultimately developing a network of thousands of testing sites across over 40 states and three CLIA-certified, high-complexity laboratories. As a result, Curative and its managed medical entities provided over 30 million COVID-19 tests and over 2 million COVID-19 vaccines.

Curative’s patient-facing services, healthcare facilities, integrated supply chain, and labs are part of a large platform we’ve built from the ground up that has allowed us to grow quickly and more efficiently than other healthcare companies. As a result, we were one of the first companies to respond to the pandemic providing COVID-19 testing at scale across the United States.

We are now implementing a new model of comprehensive healthcare delivery focused on the whole person’s well-being: providing expanded healthcare and wellness services while also streamlining access to preventative care. We are setting out to change healthcare in the United States and fundamentally re-designing the way that patients interact with their healthcare and health insurance. By building a connected platform for managing the health of our patients, we believe that we can deliver a better healthcare experience at a lower cost and with better outcomes so that our patients can focus on getting and staying well. Our model delivers healthcare by investing in patient preventive health from the start, reducing the barriers to entry to traditionally complex care networks and eliminating the concern of unexpected medical bills. Curative will launch its first members-only healthcare offering in Austin, January 2023.

For more details on Curative and to stay tuned on what’s ahead, please visit curative.com and follow on Facebook, Instagram, and Twitter.