Configuration Analyst

Curative is reimagining health insurance - with $0 out of pocket costs and by reducing barriers to people seeking care. Help us create a better healthcare experience for our members by making it easy & intuitive for them to access the care they need. We believe in a clear, simple health plan that allows our members to get zero-cost in-network care anytime they need it. We want to put healthcare back in the hands of the patient and clinicians, with a focus on preventative care.

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 HealthRules Payer Configuration Analyst 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 Responsibilities

• Configure complex professional and facility contracts within the HealthRules Payer system
• Configure and maintain HRP configuration for claims, pricing, and benefits
• Investigate and resolve configuration issues on the HealthRules Payer system to ensure timely and accurate claims payment and account implementation
• Maintain clear and accurate documentation of all configuration activities and decisions
• Prepare and execute test cases to validate that configuration changes function as expected
• Review and resolve claim pends on a daily basis to ensure claims are processed timely
• A team player; perform tasks in a very fast paced environment.
• Work on claims team projects and reporting, as assigned.
• Attend departmental training when required or requested.
• Adhere to the rules and regulations of Curative as described in the Employee Handbook and as defined in the unit/department/clinic procedures.
  
  

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:

• 3 years of health plan configuration experience within the HealthRules Payer platform; experience with 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 Suite
• 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

❑ Associate's degree (A. A.) or equivalent from two-year college or technical school; or six months to one year related experience and/or training; or equivalent combination of education and experience.