Clinical Analyst I

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

📋 Description

• Conduct daily audits on client data to ensure completeness and accuracy of coding, leveraging both coding expertise and clinical knowledge to secure appropriate reimbursement while adhering to required client turnaround times and KPI objectives.

• Address provider appeals promptly to meet established client turnaround times and KPI targets.

• Enhance product quality by providing constructive feedback to Management and Development Teams regarding potential improvements for editing and efficiency.

• Acquire a thorough understanding of claims payment policies and processing, particularly concerning CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, among others.

• Fulfill all responsibilities as specified in the annual performance evaluation and/or goal-setting process.

• Complete all assigned special projects and additional duties as required.

⛳️ Requirements

• Possess an active professional license as a Registered Nurse in your current state of residence (a BSN is preferred).

• Have a minimum of 2 years of professional experience in delivering direct patient care.

• Coding certification is preferred (Outpatient - CPC, CCS, or CCS-P) or must be obtained within the first year of employment.

• Must secure NY Independent Insurance Adjuster licensure within the first four months.

• Demonstrate a strong working knowledge of medical procedures, conditions, illnesses, and treatment practices.

• Exhibit excellent personal computer skills in the Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).

🏝️ Benefits

• Health insurance

• 401(K) savings plans

• Paid family leave

• 9 paid holidays per year

• 17-27 days of Paid Time Off (PTO) annually, based on specific level and tenure with Cotiviti