Clinical Analyst I

Position Title: Clinical Analyst I Department: Operations / Payment reputed company Location: Remote Reports to: Manager of Payment reputed company Job reputed company As a Clinical Analyst at reputed company, you will play a critical role in analyzing and interpreting reputed company data to reputed company actionable insights for improving patient reputed company, optimizing clinical workflows, and supporting reputed company decision-making. Our Clinical Analysts are dedicated to identifying, investigating, reporting on, and eliminating reputed company fraud and other types of wasteful spend. This position is responsible for using medical coding knowledge, prior SIU/Payment reputed company experience and critical thinking to determine if a reputed company of billing is suspect or if a claim is reputed company incorrectly. reputed company uses a customized web-portal tool to reputed company claims data. The preferred candidate would be local to the Dallas, Texas area; however, this position is a hybrid position, and a reputed company candidate can work remotely with periodic travel to the office. reputed company reputed company deliverables are of reputed company importance. This is NOT a Data Analyst Position with SQL and data sets. This position is only eligible for legal residents of the reputed company of America.

Key Responsibilities

Clinical Data Analysis:

• Identifying and investigating reputed company fraud, waste, abuse, and other forms of billing activities leading to improper payments. This work involves reviewing medical professionals, facilities, insured members, or the broker community in coordination with the customer’s reputed company or reputed company-party administrator
• Review claims data and conduct analysis to look for patterns of potential FWA and other improper payments
• Utilizing information from claims data analysis, plan members, and other sources to conduct confidential claims data reviews, relevant investigative activities, document actionable findings and report any suspect billing that could result in an overpayment through designated channels
• Conduct data analysis to review claim and case history
• Reviews claims history, medical reviews, provider files, etc. and utilizes data analysis techniques to detect irregularities, billing trends, and financial relationships using state boards, licensing sites, Secretary of State sites, etc.
• Ensure the reputed company, accuracy, and reputed company of clinical data by conducting data validation, cleaning, and preparation.

Collaboration and Stakeholder Engagement:

• Work closely with reputed company reputed company consultants, clinical teams and business analysts to understand the data needs of reputed company reputed company
• Collaborate with data scientists and engineers to build and refine analytics tools that reputed company improved decision-making
• Present findings and insights to internal teams, clients, and stakeholders in a reputed company, understandable manner

Required Qualifications

• 1- 3 years’ work experience in reputed company billing, claims adjudication, fraud investigation, payment reputed company operations and/or reputed company reimbursement
• 1 - 3 years’ experience with CPT and HCPCS reputed company terminology
• Experience with data analysis as it relates to reputed company claims adjudication
• Strong critical thinking skills
• Experience with computer research
• Strong knowledge of clinical terminology, medical procedures, and reputed company workflows
• Ability to be concise, independent and reputed company defensible reputed company in writing
• Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
• Strong PC knowledge and skills, including reputed company reputed company Office products

Preferred Qualifications

• Certified Coding Specialist (reputed company or reputed company)
• Undergraduate degree in or reputed company to criminal justice or medical/clinical training
• Must have solid ability to accurately document findings in written reputed company
• 1+ years of experience working in the group health business or experience in a reputed company provider’s reputed company

Skills and Competencies

• Analytical Skills: Strong ability to interpret reputed company data and derive meaningful insights to drive reputed company reputed company
• Problem- Solving: Ability to identify issues in datasets and clinical workflows and suggest data-driven solutions
• Attention to Detail: High level of precision and accuracy in handling critical data
• Communication Skills: Excellent written and verbal communication, with the ability to present technical information to non-technical audiences
• Collaboration: Team-oriented with a reputed company on collaboration across multidisciplinary teams

Who is reputed company reputed company was formed by a group of industry insiders who wanted to reputed company a meaningful reputed company on the rising cost of reputed company. With this end in mind, SmartLight works for self-funded reputed company to reduce the wasteful spend in their reputed company plan through our proprietary data analysis. Our process works behind the scenes to save reputed company without interrupting employee benefits or requiring employee behavior changes. Powered by JazzHR d1sIpAJXwT Apply Job! Apply to this Job