Senior Clinical Analyst
SmartLight Analytics
full-time
Posted on:
Location Type: Hybrid
Location: Texas • United States
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Job Level
About the role
- Possess a clear understanding of the identification and investigation of issues and billing activities leading to improper payments
- Review medical records and compare to claims data to review for billing accuracy and savings opportunities
- Utilize information from claims data analysis, plan representatives and other sources to accurately present the company’s findings to carriers
- Identify, analyze, and interpret trends or patterns in complex data sets
- Leverage available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution
- Perform review of claims resulting from overpayments related to benefits and policies
- Communicate and document findings, including trends and recommendations
- Ability to review and analyze medical records.
Requirements
- Bachelor's degree in healthcare or related field, preferred
- At least one of: RN, CPC, CCS or other relevant clinical/coding certifications required
- Minimum of 5 years of work experience in healthcare administration, billing, claims adjudication, clinical auditing, payment integrity operations and/or healthcare reimbursement
- Strong knowledge of clinical terminology, medical procedures, and healthcare workflows
- Ability to be concise, independent and provide defensible decisions in writing
- Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
- Experience in commercial payer environments
- Strong critical-thinking, communication and attention to detail skills
Benefits
- Health insurance
- 401(k) matching
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims data analysisbilling accuracymedical record reviewdata interpretationpayment resolutionclinical auditinghealthcare reimbursementpayment integrity operationstrend analysisoverpayment review
Soft skills
communication skillsdetail-orientedcritical-thinkinginterpersonal skillsindependenceconcisenessdefensible decision makingoral presentation skillswritten communication skillsanalytical skills
Certifications
RNCPCCCS