Remote Claims Data Analyst at CareNu

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing!

When you become part of the CareNu Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing groundbreaking solutions for our clients' unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success!

Remote Role – must be located in the State of Florida with minimal travel to Tampa corporate office expected
Data Analytics Responsibilities:
• Data Collection and Preparation: Gather data from various sources (databases, APIs, etc.) and ensure its quality and accuracy.
• Data Analysis: Apply statistical methods and techniques to analyze data, identify trends, and uncover insights
• Data Visualization: Present findings using charts, graphs, and other visual tools to communicate insights effectively
• Reporting and Communication: Prepare reports and presentations to communicate findings to stakeholders
• Problem Solving: Identify and address data-related issues and challenges.
• Data Modeling: Develop and maintain data models to support analysis and reporting.
• Communicate effectively with providers, their liaisons, and medical staff leadership regarding any inquiries, responding in a timely manner
• Participate in department and organization meetings and provide feedback and suggestions to solve team, department, and organization issues and or concerns
Claims Processing and Verification Responsibilities:
• Conduct thorough verification of healthcare claim submissions and data.
• Follow established internal policies and procedures related to claims.
• Conduct comprehensive analytics for all claims against regulatory requirements and contractual agreements.
• Guarantee secure handling and storage of confidential information.
• Review and process medical claims for accuracy, completeness, and compliance with insurance policies and regulations
• Verify patient data and medical information, requesting additional documentation as necessary
• Ensure proper coding and billing practices per Medicare requirements
• Identify and resolve discrepancies or errors in claims; analyze trends and recommend process improvements related to errors

Reimbursement and Payment Responsibilities:
• Determine eligibility for reimbursement based on insurance policies and provider contracts
• Negotiate payments with insurance companies and providers
• Monitor claim status and ensuring timely payments

Communication and Customer Service Responsibilities:
• Communicating with patients, providers, and insurance companies regarding claim status and resolution within the required timeframes
• Answering questions and addressing concerns with professionalism and empathy
• Provide excellent customer service and resolving issues effectively and efficiently
Other Duties:
• Remain updated on changes in healthcare regulations and coding guidelines
• Conduct audits and quality assurance reviews
• Develop risk mitigation programs
• Perform other duties as assigned

Qualifications:

·         Associate’s degree in healthcare administration, business administration or related field required; Bachelor’s degree in related field preferred

·         Minimum of ten (10) years of experience in Medicare Advantage Care claims processing setting

·         Minimum of five (5) years of experience in Medicare Advantage Care claims analytics

·         Proficiency in Structured Query Language for database management

·         Ability to communicate effectively in English required; bilingual in English/Spanish preferred

·         Data Visualization Tools: Familiarity with tools such as Tableau or Power BI.

·         Data Cleaning and Transformation: Ability to clean, transform, and prepare data for analysis

·         Proficient understanding of medical terminology

·         Ability to analyze data, identify patterns, and draw conclusions.

·         Familiar with electronic claims submissions and claim types

·         Ability to pay close attention to data accuracy and quality.

·         Advanced Microsoft Office Suite Skills

Compensation Pay Range:

$53,623.86 - $80,435.79

This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.

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