Position Overview:
The Clinical Analyst supports accurate claims processing and helps resolve billing discrepancies by reviewing healthcare data and identifying potential payment issues. This role focuses on analyzing claims, comparing medical records, and communicating findings to internal teams and responding to claims administrators.
Responsibilities
Review medical claims and related medical records to check for billing accuracy and potential savings opportunities.
Assist in identifying issues that may lead to improper payments across professional, facility, and member claims.
Analyze data to identify trends or patterns that may indicate billing or payment concerns.
Use internal and external systems to research claim information and support payment resolution efforts.
Document findings clearly, including identified issues, trends, and recommended next steps.
Support the review of claims associated with possible overpayments based on benefits or policy guidelines.
Communicate findings to internal teams and carrier partners in a clear and professional manner.
Qualifications:
Bachelor’s degree in healthcare or a related field preferred.
At least one of the following certifications: RN, CPC, CCS, or similar clinical/coding credential.
2-3 in TPA/Carrier claims processing or payment integrity related areas.
2–3 years of experience in healthcare administration, billing, claims processing, clinical auditing, payment integrity, or related areas.
Working knowledge of medical claims data, medical procedures, and healthcare workflows.
Strong attention to detail and ability to communicate clearly in writing and verbally.
Experience working with commercial health plans is a plus.
Solid analytical and critical‑thinking skills.
Bonus points for:
Familiarity with state and federal regulations related to commercial health insurance.
Experience in group health or within a healthcare provider practice.
Keys to Success:
Ability to interpret healthcare data and identify potential issues.
Strong problem‑solving skills and comfort working with detailed information.
Accuracy and thoroughness when reviewing medical records and claims.
Clear communication of findings to support decision‑making.
...Skid Steer operators needed -1st shift $25 Job Type & Location This is a Contract to Hire position based out of Wichita, KS. Pay and Benefits The pay range for this position is $18.00 - $33.00/hr. Eligibility requirements apply to some benefits and may depend...
WHO WE ARE City First Bank N.A. is a mission-driven Community Development Financial Institution (CDFI) principally focused on a transformative impact in underserved urban markets with the highest needs to drive equitable economic development. Our credit activities ...
...into Dayforce through MyApps| USA TODAY Co., Inc. is a diversified media company with expansive reach at the national and local level... ...connect with us, visit The Detroit News is seeking an outstanding Sports Editor to collaborate and direct coverage in one of the nations...
...Increasing demands have initiated recruitment efforts to add another associate physician. Work alongside 2 other Hem/Onc physicians, an oncology midlevel provider and an experienced support staff. Services provide blood and platelet transfusions, blood draws, hydration...
REQUIREMENTS/RESPONSIBILITIES:~Real Estate License preferred but not required.~Oversee all aspects of buyer & seller transactions from executed Offer to Purchase to closing.~Coordinate inspections and completion of repairs.~Maintain weekly and daily contact with...