SmartLight Analytics · 1 day ago
Sr. Clinical Analyst
United States
Full-time
Remote
Senior Level
5+ years expSmartLight Analytics is a company focused on reducing wasteful spending in healthcare for self-funded employers through proprietary data analysis. The Senior Clinical Analyst role involves analyzing healthcare data to identify improper payments, ensuring accurate claims processing, and optimizing carrier performance through effective communication and data-backed insights.
AnalyticsHealth CareInformation TechnologySoftware
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)
Review medical records and compare to claims data to review for billing accuracy and savings opportunities
Utilize information from claims data analysis, plan representatives and other sources to accurately present the company’s 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 about 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
Qualification
Required
At least one of: RN, CPC, CCS or other relevant clinical/coding certifications required
Minimum of 5 years of work experience in healthcare administration, billing, claims adjudication, clinical auditing, payment integrity operations and/or healthcare reimbursement
Strong knowledge of clinical terminology, medical procedures, and healthcare workflows
Ability to be concise, independent and provide defensible decisions in writing
Detail-oriented with excellent communication skills (oral presentations and written) and interpersonal skills
Experience in commercial payer environments
Strong critical-thinking, communication and attention to detail skills
Preferred
Bachelor's degree in healthcare or related field, preferred
An intermediate level of knowledge with Local, State & Federal laws and regulations pertaining to health insurance (commercial health plans and/or dental plans)
3+ years of experience working in the group health business or experience in a healthcare provider's practice
Company
SmartLight Analytics
SmartLight Analytics reduces health care costs for self-funded employers with analytics and results-oriented solutions.
2-10 employees
H1B Sponsorship
SmartLight Analytics has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (1)
Funding
Current Stage
Early StageLeadership Team
Asha George
CEO and Co-Founder
Franklin E Baumann, MD
Chief Medical Officer and Co-Founder
Company data provided by crunchbase