SAU Analyst

Curative • Austin, TX

250d

About The Position

SAU Analyst Curative is searching for an SAU Analyst to review claims for completeness and process per plan guidelines as well as work on detailed projects and audits for all lines of business, as assigned. Carries out all duties while maintaining compliance and confidentiality and promoting the mission of the organization.

Requirements

• At least 3 years of experience in claims benefit review/ adjudication and adjustments, including PPO and/or Medicaid.
• Experience with various claim payment systems in processing hospital, mental health, dental and routine medical claims within given deadlines.
• Experience working on/ with the HealthEdge claims system will be extremely beneficial in this role.
• At least 3 years Auditing experience.
• Knowledge of medical terminology, ICD-10, CPT, and HCPCS coding, TDI and CMS regulations and multi-states regulation/ audit experience required.
• Working Knowledge of Google, 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 to communicate clearly and effectively with all levels of staff, members and providers.
• Ability to be detail oriented, 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.

Responsibilities

• Reviews claims, appeals and reconsiderations for compliance with plan guidelines and approves or denies payment using established guidelines, policy and procedures and plan directives.
• Documents clearly and concisely all claims adjudication decisions in Claim Notes.
• Consults appropriate reference materials to verify proper coding.
• Identifies potential problems and claims training issues discovered during review of claims referrals and appeals; refers for resolution to manager; tracks and trends claim processing errors.
• 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.
• Ability to meet/maintain the required accuracy and production standards after release from training.
• Handles 'special projects' as dictated by the client's request. Reviews for claim payment accuracy, member out of pocket calculation accuracy (if applicable), etc.
• Adheres to rules and regulations of Curative as described in the employee handbook and in the unit/department/clinic procedures.
• Creates databases, spreadsheets, or tables as required to facilitate the compilation of data for special project and/or ad hoc reporting assignments.
• Provides review and mentoring for other SAU Analysts and Claims department.
• Performs other duties, functions and projects, as assigned, by team management.

What This Job Offers

• Industry: Personal and Laundry Services
• Education Level: High school or GED