Operations Fulfillment Analyst at HOKALI collaborating with educators to ensure service levels. Managing operational tasks and identifying improvement opportunities while working in a hybrid setup.
About the role
- Senior Clinical Analyst at SmartLight Analytics combining clinical data expertise with relationship management. Analyzing healthcare data to identify improper payments and driving resolutions through insights.
Responsibilities
- 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
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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