State Licensed Clinical Rules Analyst

Job Summary

A company is looking for a Clinical Rules, Sr. Analyst to develop and maintain custom claims editing rules remotely.

Key Responsibilities:

• Design, test, release, and maintain custom data-driven rules using Content and Rules Studio and Claims Manager
• Support the timely deployment of custom knowledge base packages and manage multiple assignments
• Collaborate with cross-functional teams to identify and implement process improvements

Required Qualifications:

• 5+ years of experience in claims processing and reimbursement policy in a healthcare field
• Experience creating data-driven rules in Claims Manager or Claims Edit System
• Proficiency in Microsoft Office tools (Outlook, Word, Excel)
• Medical coding credentials (e.g., CPC, CCS, RHIT, RHIA) and/or relevant coding experience