Clinical Analyst

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Evaluate clinical and healthcare-related cases

• Conduct utilization management, utilization reviews, and prior authorization assessments

• Analyze claims, denials, billing issues, and medical necessity

• Engage in communication with providers and manage provider calls

• Research and interpret healthcare regulations and policies

• Investigate cases and address any issues

• Generate reports using Excel

• Document and uphold SOPs and processes

• Ensure coverage from 8 AM–6 PM EST

⛳️ Requirements

• US citizenship is mandatory due to federal regulations and sensitive job responsibilities

• Capability to secure Public Trust Clearance

• Experience in US healthcare, US payer systems, or provider environments

• Background in utilization management, utilization review, or prior authorization

• Educational experience in clinical or healthcare fields

• Familiarity with ICD-10, CPT, and HCPCS coding systems

• Proficiency in claims, denials, billing, or medical necessity evaluation

• Skills in provider communication and managing provider calls

• Experience in healthcare policy research and analysis

• Competence in case investigation and problem resolution

• Proficient in Excel and report generation

• Experience with documentation of SOPs and processes

• Excellent written and verbal communication skills

• Availability for coverage from 8 AM–6 PM EST

🏝️ Benefits

• Comprehensive health insurance options

• Opportunities for professional development and training

• Flexible working arrangements