Clinical Analyst

Clinical Analyst

Investigate and resolve provider inquiries, including dismissals (e.g., incorrect CPT codes, ineligible beneficiary) and no-response cases.

Prepare dashboards, audit summaries, SOP updates, and RCA documentation.

Identify gaps, errors, and improvement opportunities across billing, coding, pends, denials, and utilization review.

Collaborate with operations, coding, QA, and client teams to ensure accurate and timely case resolution.

Ensure availability during business hours: 8:00 AM 6:00 PM EST

Skills

Working knowledge of ICD, CPT, and HCPC nomenclature.

Ability to direct analysts using Python and other coding tools for data cleaning, automation, and analytical reporting.

Experience in using MongoDB

Experience with AWS S3

Required Skills & Qualifications

Bachelor s degree in Life Sciences, Nursing, Pharmacy, or a related healthcare discipline.

Strong understanding of the US healthcare ecosystem, including data taxonomies and transaction standards commonly used.

Excellent verbal and written communication skills.

Ability to manage calls and email interactions with internal and external stakeholders.

Proficiency in Excel, reporting tools, and structured documentation of cases, SOPs, reports and other artifacts