Clinical Analyst with RN Certification

Job Summary

A company is looking for a Clinical Analyst to support accurate claims processing and resolve billing discrepancies.

Key Responsibilities

• Review medical claims and related records for billing accuracy and savings opportunities
• Identify issues leading to improper payments across various claims
• Analyze data to detect trends indicating billing or payment concerns

Required Qualifications

• Bachelor's degree in healthcare or a related field preferred
• At least one certification such as RN, CPC, CCS, or similar clinical/coding credential
• 2-3 years in TPA/Carrier claims processing or payment integrity related areas
• 2-3 years of experience in healthcare administration, billing, claims processing, or clinical auditing
• Working knowledge of medical claims data and healthcare workflows