State Licensed Clinical Analyst

A company is looking for a Senior Clinical Analyst to combine clinical data expertise with relationship management to ensure accurate claims processing and optimize carrier performance.

Key Responsibilities

Investigate issues and billing activities leading to improper payments by reviewing medical claims data

Present findings to carriers clearly to ensure understanding and remediation of inappropriate payments

Analyze trends in complex data sets and communicate findings, including recommendations for resolution

Required Qualifications

Bachelor's degree in healthcare or related field, preferred

At least one relevant clinical / coding certification (e.g., RN, CPC, CCS) required; multiple certifications preferred

A minimum of 5 years of experience in healthcare payment integrity, clinical auditing, or claims management

Experience in commercial payer environments