Curana Health is a provider of value-based primary care services for the senior living industry, including skilled nursing facilities, assisted & independent living communities, Memory Care units, and affordable senior housing sites. Our 1,000+ clinicians serve more than 1,500 senior living community partners across 34 states, and Curana participates in various innovative CMS programs (including owned-and-operated Accountable Care Organizations and Medicare Advantage plans). With rapid year-over-year growth since our founding in 2021, Curana is setting a new standard in innovative care delivery for seniors with high-risk, complex clinical needs, many of whom have been historically underserved by the healthcare system. Our mission: To radically improve the health, happiness and dignity of senior living residents.
Essential Duties and Responsibilities
- Provide comprehensive support to Care Allies, Advanced Practice Providers (APPs), and facilities by ensuring seamless access to necessary systems and tools.
- Conduct thorough claims reviews and assist with resolution of inquiries.
- Manage, triage, and respond to website inquiries efficiently.
- Support quality improvement efforts by assisting with PQI and grievance processes.
- Serve as a liaison for vendors, facilities, and providers regarding authorization and claims-related questions.
- Facilitate tracking and retrieval of primary care provider (PCP) agreements.
- Engage with providers to onboard them into the network and enhance network accessibility.
- Educate vendors and facilities on billing procedures and assist with resolving portal issues.
- Deliver portal training sessions and address system-related issues.
- Conduct annual reviews of benefit documents and marketing materials to identify and rectify errors.
- Compile and present data, metrics, and agenda items for partner meetings.
- Support network management by addressing credentialing, provider updates, and maintaining accurate rosters.
- Address disenrollment issues and resolve miscellaneous concerns.
- Foster engagement by visiting partner locations and offering on-site assistance.
- Assist the sales team with educational initiatives, including Lunch and Learn sessions.
- Handle vendor, facility, and member inquiries related to ASC letters, escalating and resolving issues as needed.
- Manage inbound calls and emails from vendors, facilities, members, and families to address a variety of issues, including OTC benefits, provider or medication lookups, and service coverage inquiries.
- Partner with sales teams to provide broker education and support ad hoc needs.
- Collaborate on process development for current and future organizational needs, such as CRM updates, disenrollment procedures, and item ordering.
- Provide ad hoc support to the plan management team, including coordination of meetings with partners.
- Perform other duties as assigned, contributing to team and organizational success.
Requirements:
- Proven experience in healthcare, preferably within skilled nursing facilities or similar settings.
- Associate or Bachelor’s degree in Healthcare, Nursing, or a related field.
- Active RN or LPN license is highly preferred.
- Strong familiarity with claims review processes.
- Advanced proficiency in Microsoft PowerPoint and Excel, with the ability to create compelling presentations and analyze data effectively.
Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances.
The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment.
