Clinical Analyst
Global Alliant•Baltimore, MD
•Remote
About The Position
The Clinical Analyst role requires a strong understanding of the US Healthcare system, specifically within payer or provider settings. The position involves working with utilization management processes, including utilization review and prior authorization. Candidates will be responsible for investigating cases, resolving issues, researching healthcare policies, and documenting processes. Excellent communication skills are essential for interacting with providers and for written documentation. The role requires the ability to work within a specified coverage window.
Requirements
- US citizenship due to federal regulations.
- Ability to obtain Public Trust Clearance.
- US Healthcare / US Payer / Provider experience.
- Experience with Utilization Management / Utilization Review / Prior Authorization.
- Clinical or healthcare educational background.
- Knowledge of ICD-10, CPT, HCPCS.
- Experience with claims, denials, billing, or medical-necessity review.
- Provider communication and provider calls experience.
- Healthcare policy research and interpretation skills.
- Case investigation and issue resolution skills.
- Proficiency in Excel and reporting.
- Experience with SOP/process documentation.
- Strong written and verbal communication skills.
- Availability to work 8 AM–6 PM EST coverage.
Responsibilities
- Conducting utilization management and utilization review.
- Processing prior authorizations.
- Investigating cases and resolving issues.
- Researching and interpreting healthcare policies.
- Communicating with providers.
- Documenting Standard Operating Procedures (SOPs) and processes.
- Performing medical-necessity reviews.
- Handling claims, denials, and billing inquiries.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Upload and Match Resume
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
