The Rawlings Group
Complex Clinical Review Analyst
This job is now closed
Job Description
- Req#: 193058
Employer Industry: Healthcare Intelligence
Why consider this job opportunity:
- Salary up to $115,000
- Comprehensive benefits package including health, vision, dental coverage, and 401(k) with company match
- Generous PTO, paid holidays, and volunteer days
- Remote work flexibility and hybrid options available
- Opportunities for career progression and personal development
- Tuition reimbursement and company-paid benefits like life insurance and parental leave
What to Expect (Job Responsibilities):
- Conduct thorough clinical and coding reviews of facility claims, ensuring accuracy in billed charges
- Assess clinical aspects of claims to confirm appropriate levels of care are billed
- Research client-specific policies and coding standards to identify experimental charges
- Analyze medication charges for correct utilization and potential off-label use
- Develop and refine resources to enhance complex claims review content
What is Required (Qualifications):
- Bachelor of Science in Nursing (BSN) required
- 2+ years of experience in complex claims or itemized bill review
- 3+ years of experience in healthcare billing and coding
- Strong research, data analysis, and attention to detail
- Proficient in Microsoft Office Suite, including advanced Excel and PowerPoint skills
How to Stand Out (Preferred Qualifications):
- Background in the healthcare payment integrity industry
- Proven ability to manage multiple projects in a fast-paced environment
- Experience collaborating with development teams and familiarity with software applications
- Excellent written, verbal, organizational, and problem-solving skills
- Ability to work independently while collaborating across teams
#HealthcareIntelligence #RemoteWork #CareerGrowth #HealthcareBilling #InsuranceClaimsAbout the company
The Rawlings Group has an unbeaten record of recovering more money for more health plans than any other vendor. Contact us today.
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