Clinical Analyst I

About the role

This Coding Validation Analyst I position will perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical knowledge and background to ensure appropriateness for reimbursement and will also respond to provider appeals.

Responsibilities

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals.
• Respond to provider appeals and meet required client turnaround time and KPI goals.
• Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
• Utilize Coding Validation specific training to become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting.
• Complete all special projects and other duties as assigned.

Qualifications

• Active professional license as a Registered Nurse in your current state of residence (BSN preferred).
• 2 years of professional experience in providing direct patient care.
• Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) or required to obtain within 1st year of employment.
• Required to obtain NY Independent Insurance Adjuster licensure within the first four months.
• Strong working knowledge of medical procedures, conditions, illnesses, and treatment practices.
• Has excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).

Physical Requirements And Working Conditions

This position may require after-hours, weekend, or holiday hours to accomplish client objectives. Remaining in a stationary position, often standing or sitting for prolonged periods. Repeating motions that may include the wrists, hands, and/or fingers. Must be able to provide a dedicated, secure work area that is free from distractions, to allow and maintain high levels of productivity. Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Pay

Base compensation ranges from $34.00 to $38.00 per hour. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Schedule

Shifts include (after training): first, second and third shifts MT with rotating weekends and holidays. Each employee should plan on working rotating weekends and holidays, and that may include early mornings, evenings, nights, weekends, and rotating holidays (everyone is required to be flexible).