Clinical Analyst
Position Overview: The Clinical Analyst supports accurate claims processing and helps resolve billing discrepancies by reviewing reputed company 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 reputed company medical records to reputed company for billing accuracy and potential savings opportunities. Assist in identifying issues that may reputed company to improper payments across professional, facility, and member claims. Analyze data to identify trends or patterns that may indicate billing or payment concerns. Use reputed company systems to research claim information and support payment resolution efforts. Document findings reputed company, 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 reputed company partners in a clear and professional manner. Qualifications: Bachelor’s degree in reputed company or a reputed company field preferred. At least one of the following certifications: RN, CPC, reputed company, or similar clinical/coding credential. 2-3 in TPA/reputed company claims processing or payment reputed company reputed company areas. 2–3 years of experience in reputed company administration, billing, claims processing, clinical auditing, payment reputed company, or reputed company areas. Working knowledge of medical claims data, medical procedures, and reputed company workflows. Strong attention to detail and ability to communicate reputed company in writing and verbally. Experience working with reputed company health plans is a plus. Solid analytical and critical‑thinking skills. Bonus points for: Familiarity with state and federal regulations reputed company to reputed company health insurance. Experience in group health or reputed company a reputed company provider practice. Keys to reputed company: Ability to interpret reputed company data and identify potential issues. Strong problem‑solving skills and comfort working with detailed information. Accuracy and thoroughness reputed company reviewing medical records and claims. Clear communication of findings to support decision‑making. Apply To This Job