System Business Analyst

SUMMARY

This is a remote position.

ESSENTIAL DUTIES AND FUNCTIONS:

• Work closely with Senior Management to collaborate on strategy to meet company goals.
• Collaborate closely with the Client Services, Product, and Engineering teams in planning and execution of strategic objectives.
• Lead a high-performing team of analysts responsible for the development and support of product configurations that drive our world-class software products.
• Successfully Lead the System Configuration team day-to-day operations of the Curative
• Consistently ensure the tasks for System Configuration teams are performed and completed & communicated to the other team members
• Coordinate the planning, prioritization, and timeline of work tied to meeting company and team goals while closely tracking and communicating around the complex network of dependencies (and potential blockers)
• Become a subject matter expert and leader in our business, Health Edge product
• Lead by example, taking a senior role in the day-to-day work of the team.
• Provide guidance and leadership in the implementation and maintenance of processes and systems to mature the operations of the team
• Develop a humble, fun-loving, and highly communicative and collaborative team culture.
• Develop key milestones for the team and lead the execution of team initiatives.
• As part of a growing company, all employees wear multiple hats and contribute to the success of our company in multiple ways.
• Contribute to the growth of the company by helping the team succeed and meet team goals.
• Foster a pleasant working environment that inspires the team.
• Self-motivation to have an outsized impact with minimal oversight.
• Ability to see the big picture and make connections based on daily operations.
• Work closely with IT, Medical Services, System Support, to ensure efficiency
• Provider Contracts Configuration and design changes in Health Edge.
• Daily Work with the Claims Processing team to ensure day-to-day claims processing are being handled in a timely manner.
• Works on claims team projects and reporting, assigned.
• Attending 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.
• SaaS software experience.
• Health Insurance industry experience.

Experience:

• At least 10-12 years of Health Care EDI 837’s, Claims Processing E2E and Health Plan Configuration along with Knowledge of Optum Products such as CES/PPS Health Edge experience required, including HMO, PPO, ERISA, and Medicare Advantage, Medicaid plans experience. Knowledge of CMS Fee schedules
• Required 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 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 EDI 837’s
• Health Edge HRP and Optum Interfaces expertise
• SQL knowledge is required