Rn Clinical Analyst Jobs

Overview

6 Degrees Health is a rapidly growing, nationally positioned cost containment company in the self-funded health insurance industry. Through accountability, engagement, and continuous improvement, we leverage passion and exemplary customer service to support our stakeholders in making informed financial decision about healthcare reimbursement. Our team of industry experts work with health plans to make the most of their healthcare dollars, which allows them to pass along the savings back to their members. We are currently seeking an RN Clinical Analyst to join our fun, fast-paced environment. This is a full-time remote position.

Job Summary

• To identify the training needs of clinical review staff and direct, coordinate and supervise the development of their competency and professional skills through teaching, mentoring and support
• Ensure that business decisions and processes are documented in a professional manner with due confidentiality
• Uphold the department’s goals and values, and contribute to its efficient development and growth
• Understand all policies and procedures relevant to the claims cycle and the clinical review process, liaise with all departments involved in the claims cycle and observed billing trends
• Organize and prioritize workload of the team
• Ensure that medical ethics and professionalism are maintained during the fulfilment of all tasks
• Offer technical support by continuous assessment and feedback concerning data quality and proper encoding of services
• Clinical review includes the evaluation of billing practices using clinical expertise to identify where providers are unbundling, up-coding, and demonstrating billing errors
• To develop and expand clinical review policies and program enhancements
• Conduct data driven reviews of healthcare service providers, checking, and evaluating the accurately of charges on the itemized bill and related documentation to ensure payment for accurately billed charges prior to payment
• Prepare the final review report following a clinical review and investigation; communicate the findings and initiates the corrective adjustments, if any

Job Responsibilities

• Support clinical review with resolution and appeals
• Conduct daily clinical claim reviews as assigned and within SLA’s
• Participate in continuing education to further understand industry billing practices and regulations
• Accurately document and prepare final review reports for client and providers
• Conduct periodic quality reviews for program enhancement
• Provide peer training and education on clinical review across the organization
• Ensure that medical ethics and professionalism are maintained during the fulfilment of all tasks

Minimum Requirements

• AAPC coding certification preferred
• Bachelor of Science Degree in Nursing; Master’s degree preferred
• Unencumbered RN license

Essential Role Functions

• Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary
• Must have the ability to read and understand various process flows and procedures
• Must be able to operate computers and phones to support position requirements
• Must be able to sit or stand for two hours at a time
• Strong Microsoft Office Skills are a must
• Strong internal and external communication skills, both verbal and written

Organizational Benefits

• 401k Program
• Fully Remote & Flexible Work Environment
• Training and Development Opportunities
• Remote Work Stipend
• Paid Holidays
• Unlimited Paid Time Off
• Medical, Dental, Vision and Other Outstanding Ancillary Benefits

The base salary range for this position is between $80,000 and $90,000, plus benefits. Please note that the base salary range is a guideline, and that individual compensation will vary based on factors such as overall qualifications, skillsets, competencies, and work location.

At 6 Degrees Health, we understand that an outstanding team is the building block of any organization. With a solid foundation, achieving our goals becomes a reality. We are dedicated to creating a safe and inclusive environment for our employees, and those in our communities, and we believe that our community is stronger when everyone is included and appreciated. We are committed to learning, listening, and improving, while celebrating the diversity and humanity of all people. We are committed to providing opportunities for engagement in decision making and ensuring safe transparency to express and challenge ideas.

6 Degrees Health, Inc. provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, or any other characteristic protected by state, federal, or local law.

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