Clinical Analyst

Clinical Analyst

• Investigate and resolve provider inquiries, including dismissals (e.g., incorrect CPT codes, ineligible beneficiary) and no-response cases.
• Prepare dashboards, audit summaries, SOP updates, and RCA documentation.
• Identify gaps, errors, and improvement opportunities across billing, coding, pends, denials, and utilization review.
• Collaborate with operations, coding, QA, and client teams to ensure accurate and timely case resolution.
• Ensure availability during business hours: 8:00 AM 6:00 PM EST
• Skills:

• Working knowledge of ICD, CPT, and HCPC nomenclature.
• Ability to direct analysts using Python and other coding tools for data cleaning, automation, and analytical reporting.
• Experience in using MongoDB
• Experience with AWS S3

Required Skills & Qualifications

• Bachelor s degree in Life Sciences, Nursing, Pharmacy, or a related healthcare discipline.
• Strong understanding of the US healthcare ecosystem, including data taxonomies and transaction standards commonly used.
• Excellent verbal and written communication skills.
• Ability to manage calls and email interactions with internal and external stakeholders.
• Proficiency in Excel, reporting tools, and structured documentation of cases, SOPs, reports and other artifacts