The Role
Perform clinical reviews for utilization management and prior authorization for a federal healthcare payer/provider client. Review claims, denials, billing, and medical-necessity; conduct case investigations; communicate with providers; interpret healthcare policy; produce reports and SOP/process documentation using Excel. Must be US citizen, able to obtain Public Trust clearance, and cover 8 AM–6 PM EST.
Summary Generated by Built In
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
Skills Required
- US citizenship
- Ability to obtain Public Trust Clearance
- US Healthcare / US Payer / Provider experience
- Utilization Management / Utilization Review / Prior Authorization
- Clinical or healthcare educational background
- ICD-10, CPT, HCPCS knowledge
- 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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The Company
