Registered Nurse Clinical Analyst

Job Summary

Performing daily audits on client data for coding accuracy, the full-time hourly Registered Nurse Clinical Analyst will utilize clinical knowledge to ensure proper reimbursement while responding to provider appeals in a remote, flexible shift environment.

Key responsibilities

• Conduct daily audits on client data to verify coding completeness and accuracy, meeting turnaround time and KPI goals
• Respond to provider appeals and provide feedback to management on process improvements
• Utilize coding validation training to understand claims payment policies and regulations

Required qualifications

• Active professional license as a Registered Nurse in the current state of residence (BSN preferred)
• Two years of professional experience in direct patient care
• Coding Certification preferred (CPC, CCS, or CCS-P) or required to obtain within the first year of employment
• Ability to obtain NY Independent Insurance Adjuster licensure within the first four months
• Strong working knowledge of medical procedures, conditions, and treatment practices