Sr. Clinical Analyst

Position Overview :

The Senior Clinical Analyst role combines clinical data expertise with relationship management to ensure accurate claims processing resolve billing discrepancies and optimize carrier performance. The analyst plays a key role in identifying improper payments communicating findings and driving resolution through data-backed insights.

This is NOT a Data Analyst Position with SQL and data sets.

Responsibilities :

• Possess a clear understanding of the identification and investigation of issues and billing activities leading to improper payments is required as this work involves reviewing medical claims data (professionals facilities insured members or the broker community).
• Utilize information from claims data analysis plan representatives and other sources to accurately present the companys findings to carriers in a way ensuring they will understand the issues and take recommended actions to remediate said inappropriate payments.
• Identify analyze and interpret trends or patterns in complex data sets
• Leverage available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution
• Perform review of claims resulting from overpayments related to benefits and policies
• Consider the financial impact of referrals with regard to identified savings and the potential of favorable resolution during the approval process
• Communicate and document findings including trends and recommendations
• Ability to review and analyze medical records.

Qualifications :

Who is SmartLight Analytics

SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes.

Required Experience :

Manager

Key Skills

CSS,Cloud Computing,Health Education,Actuary,Building Electrician

Employment Type : Full-Time

Experience : years

Vacancy : 1