Sr. Clinical AnalystSmartLight Analytics • Plano, TX, US
Sr. Clinical Analyst
SmartLight Analytics • Plano, TX, US
job_description.job_card.variable_days_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.full_time
- serp_jobs.filters_job_card.quick_apply
job_description.job_card.job_descriptionPossess a clear understanding of the identification and investigation of issues and billing activities leading to improper payments is required as this work involves reviewing medical claims data (professionals, facilities, insured members, or the broker community). Utilize information from claims data analysis, plan representatives and other sources to accurately present the company’s findings to carriers in a way ensuring they will understand the issues and take recommended actions to remediate said inappropriate payments. Identify, analyze, and interpret trends or patterns in complex data sets Leverage available resources and systems (both internal and external) to analyze claim information and take appropriate action for payment resolution Perform review of claims resulting from overpayments related to benefits and policies Consider the financial impact of referrals with regard to identified savings and the potential of favorable resolution during the approval process Communicate and document findings, including trends and recommendations Ability to review and analyze medical records. Bachelor's degree in healthcare or related field, preferred At least one of : RN, CPC, CCS or other relevant clinical / coding certifications required, Multiple would be preferred A minimum of 5 years of experience in healthcare payment integrity, clinical auditing or claims management Experience in commercial payer environments Strong critical-thinking, communication and attention to detail skills Who is SmartLight Analytics SmartLight Analytics was formed by a group of industry insiders who wanted to make a meaningful impact on the rising cost of healthcare. With this end in mind, SmartLight works for self-funded employers to reduce wasteful spending in their healthcare plan through our proprietary data analysis. Our process works behind the scenes to save money without interrupting employee benefits or requiring employee behavior changes. Powered by JazzHR
Position Overview :
- The Senior Clinical Analyst role combines clinical data expertise with relationship management to ensure accurate claims processing, resolve billing discrepancies, and optimize carrier performance.
- The analyst plays a key role in identifying improper payments, communicating findings, and driving resolution through data-backed insights.
Responsibilities :
Qualifications :
serp_jobs.job_alerts.create_a_job
Sr Analyst • Plano, TX, US
Job_description.internal_linking.related_jobs
When you're the best, we're the best.We instill an environment where employees feel engaged, satisfied and able to contribute their unique skills and talents.
We provide extensive opportunities for ...serp_jobs.internal_linking.show_more
Please note : This position is hybrid based in Irving, Texas and requires in-office attendance Monday through Thursday, with the option to work from home on Fridays.
Under the direction of the Direct...serp_jobs.internal_linking.show_more
Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers.We serve more than 750 payers, including the top five national health plans, regional hea...serp_jobs.internal_linking.show_more Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers.We serve more than 750 payers, including the top five national health plans, regional hea...serp_jobs.internal_linking.show_more 
TX190 : 2501 West University, McKinney 2501 West University , McKinney, TX, 75070 USA.Person, or Immigration Status Requirements : .
At Raytheon, the foundation of everything we do is rooted in our va...serp_jobs.internal_linking.show_more
McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare.We are known for delivering insights, products, and services that make quality care more accessibl...serp_jobs.internal_linking.show_more
A company is looking for a Senior Research Coverage Analyst.Key Responsibilities Prepare Medicare Coverage Analysis, internal billing grids, and clinical trial budgets Negotiate clinical trial b...serp_jobs.internal_linking.show_more A company is looking for a Senior Clinical Analyst to combine clinical data expertise with relationship management to ensure accurate claims processing and optimize carrier performance.Key Responsi...serp_jobs.internal_linking.show_more 
Senior Manager, Business Analysis.The Senior Manager, Business Analysis provides financial and business thought leadership to drive system sales growth, improve unit economics, and enable informed ...serp_jobs.internal_linking.show_more
Strategic Sales Leadership Position.Our purpose is to help clients exceed their financial health goals.Across the reimbursement cycle, our scalable solutions and clinical expertise help solve progr...serp_jobs.internal_linking.show_more In this role, you will develop analytical insights to identify payment anomalies in client’s healthcare claims data.To be successful in the role, you will have sound knowledge and experience ...serp_jobs.internal_linking.show_more 
McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare.We are known for delivering insights, products, and services that make quality care more accessibl...serp_jobs.internal_linking.show_more
Are you ready to explore a world of possibilities, both at work and during your time off? Join our American Airlines family, and you’ll travel the world, grow your expertise and become the best ver...serp_jobs.internal_linking.show_more McKesson is an impact-driven, Fortune 10 company that touches virtually every aspect of healthcare.We are known for delivering insights, products, and services that make quality care more accessibl...serp_jobs.internal_linking.show_more 
Clinical Research Associate II / Sr CRA - Full Service - ONC + Gen Med (Home-Based in Central US).Syneos Health is a leading fully integrated biopharmaceutical solutions organization built to accel...serp_jobs.internal_linking.show_more
Join our Team - We're Growing and Seeking a Skilled Sr.Director of Clinical Services (BCBA) at our McKinney Treatment Center in McKinney, TX.
Behavioral Innovations has been a trusted provider of co...serp_jobs.internal_linking.show_more
Join our Team - We're Growing and Seeking a Skilled Sr.Director of Clinical Services (BCBA) at our McKinney Treatment Center in McKinney, TX.
Behavioral Innovations has been a trusted provider of co...serp_jobs.internal_linking.show_more
Analyst CIP Compliance position will be responsible for providing leadership, independent compliance oversight, guidance, and direction needed to maintain on-going compliance with all applicable NE...serp_jobs.internal_linking.show_more
Clinical Analyst
Vizient, Inc. • Irving, TX, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr. Compensation Analyst
Michaels Stores • Irving, TX, US
serp_jobs.job_card.full_time +1
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr Analyst Compliance
Zelis Healthcare, LLC • Plano, TX, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Sr. Supervisor, Clinical Chart Review
Zelis Healthcare, LLC • Plano, TX, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr Analyst, Tech Publications
Raytheon • McKinney, TX, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr. Technology FinOps Analyst
McKesson • Irving, TX, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Senior Clinical Research Analyst
VirtualVocations • Plano, Texas, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_hours • serp_jobs.job_card.promoted • serp_jobs.job_card.new
State Licensed Clinical Analyst
VirtualVocations • Mesquite, Texas, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Sr. Manager, Business Analyst
Yum Brands • Plano, TX, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr Regional VP, Clinical Documentation
CorroHealth • Plano, TX, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr. Data Analyst
SmartLight Analytics • Plano, TX, US
serp_jobs.job_card.full_time
serp_jobs.filters_job_card.quick_apply
serp_jobs.last_updated.last_updated_30
Sr. Financial Analyst
MCKESSON • Irving, TX, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Analyst / Sr Analyst, Compensation
American Airlines • Dallas, TX, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr. Technology FinOps Analyst
MCKESSON • Irving, TX, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Clinical Research Associate II / Sr CRA - Full Service - ONC + Gen Med (Home-Based in Central US)
Syneos Health / inVentiv Health Commercial LLC • Plano, TX, United States
serp_jobs.filters.remote
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Sr. Director of Clinical Services
Behavioral Innovations • Mckinney, TX, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
Sr. Director of Clinical Services (McKinney)
Behavioral Innovations • McKinney, TX, US
serp_jobs.job_card.part_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Sr. Analyst CIP Compliance
TXU Energy • Irving, TX, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted