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AI Summary
The Clinical Analyst will perform medical-necessity reviews, manage prior authorizations, and handle claims or denials. They are also responsible for healthcare policy interpretation, case investigation, and maintaining detailed process documentation.
Job Title: Clinical Analyst
Job Location: Remote
Job Duration: Contract / FTE
Client: Federal
Criteria- Need US citizenship because of federal regulations and the sensitive nature of the work involved.
Ability to obtain Public Trust Clearance
Must-have skills
- US Healthcare / US Payer / Provider experience
- Utilization Management / Utilization Review / Prior Authorization
- Clinical or healthcare educational background
- ICD-10, CPT, HCPCS
- Claims, denials, billing or medical-necessity review
- Provider communication / provider calls
- Healthcare policy research and interpretation
- Case investigation / issue resolution
- Excel and reporting
- SOP/process documentation
- Strong written and verbal communication
- Able to work 8 AM–6 PM EST coverage
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