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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
$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.
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
- 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
- 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
- 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
- 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
- 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
$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.
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
$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.
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
- 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
- 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
- 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
- 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
- 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
$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.