Clinical Analyst Clinical Validation

JOB TITLE:

REPORTS TO: Team Leader/Asst. Manager

PRINCIPLE PURPOSE OF JOB

We are currently seeking Clinical Analyst to support a growing client base while combining their clinical and/or coding expertise with payment accuracy. The Research Analyst is responsible for analyzing and interpreting and assign the correct codes for the descriptions available on various medical procedures and diagnosis and other related medical coding as per the medical policy requirements

JOB RESPONSIBILITIES

• Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement
• Respond to provider appeals.
• Respond to client logics and record reviews
• Monitor acceptance rates for assigned clients and assist management in proactively detecting negative deviations.
• Contribute to PCI product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency.
• Reports his/her work performance on a timely basis to the team lead
• Works diligently to meet and exceed productivity and quality benchmarks
• Takes charge of ongoing learning and development and participates in relevant training and development activities

ATTRIBUTES AND BEHAVIORS

• Develops and maintains positive working relationships with others
• Shares ideas and information Ability to collaborate efficiently.
• Assists colleagues unprompted
• Takes pride in the achievement of team objectives
• Has credibility with peers and senior managers
• Self-motivated – driven to achieve results
• Works with a sense of urgency
• High customer service ethic – is passionate about meeting customer expectations and improving service levels
• Keeps pace with change – acquires knowledge/skills as the business evolves
• Handles confidential information with sensitivity.

RELEVANT EXPERIENCE & EDUCATIONAL REQUIREMENTS

• Medical degree (MBBS or BAMS or BHMS or B.P.Th) with CPC certification
• Experience in US Healthcare, medical coding, medical billing, RCM health plan operations strongly preferred.
• Possesses knowledge of healthcare claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-9, CPT & HCPCS, etc.
• Practical clinical experience working in a hospital/office or nursing home strongly preferred.
• Has general knowledge of medical procedures, conditions, illnesses and treatment practices
• Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency
• Has excellent personal computer skills in Microsoft Word, Excel, PowerPoint, Outlook, etc.

SKILLS & COMPETENCIES

• Strong analytical, critical thinking and problem-solving skills
• Excellent verbal and written communication skills
• Be a quick learner and proficient in application of learnings
• Excel proficiency
• Strong organizational skills and adaptive capacity for rapidly changing priorities and workloads
• Ability to work well independently and maintain focus on a topic for prolonged periods of time