Clinical Claims Analyst, RN

Job Summary

Reviewing facility claims for accuracy, the full-time remote Complex Clinical Claims Analyst, RN will analyze billed charges against medical records, assess clinical appropriateness, and develop resources to support claim determinations.

Key responsibilities

• Perform detailed clinical and coding reviews of facility claims, including itemized statements and medical records
• Research medical policies and clinical guidelines to identify experimental charges and ensure billing accuracy
• Collaborate with internal teams and assist in staff training while managing productivity and audit accuracy

Required qualifications

• Bachelor of Science in Nursing (BSN), RN, LPN, or LVN
• Minimum of 2 years of experience in complex claims/itemized bill review
• At least 3 years of experience in healthcare billing and coding
• Strong background in healthcare payment integrity
• Proficient in Microsoft Office Suite and capable of working in a remote environment