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SmartLight Analytics logo
SmartLight Analytics

Harness the power of your healthcare data

Clinical Analyst

AnalystAnalystFull TimeRemoteMid LevelTeam 1-10Since 2016H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

36 days ago

Salary

0

Seniority

Mid Level

Bachelor Degree2 yrs expEnglish

Job Description

Clinical Analyst

SmartLight Analytics

• Review medical claims and related medical records to check for billing accuracy and potential savings opportunities. • Assist in identifying issues that may lead to improper payments across professional, facility, and member claims. • Analyze data to identify trends or patterns that may indicate billing or payment concerns. • Use internal and external systems to research claim information and support payment resolution efforts. • Document findings clearly, including identified issues, trends, and recommended next steps. • Support the review of claims associated with possible overpayments based on benefits or policy guidelines. • Communicate findings to internal teams and carrier partners in a clear and professional manner.

Job Requirements

  • Bachelor’s degree in healthcare or a related field preferred.
  • At least one of the following certifications: RN, CPC, CCS, or similar clinical/coding credential.
  • 2-3 in TPA/Carrier claims processing or payment integrity related areas.
  • 2–3 years of experience in healthcare administration, billing, claims processing, clinical auditing, payment integrity, or related areas.
  • Working knowledge of medical claims data, medical procedures, and healthcare workflows.
  • Experience working with commercial health plans is a plus.
  • Solid analytical and critical‑thinking skills.

Benefits

  • Health insurance
  • Flexible work arrangements
  • Professional development

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