Company: Helton Law Group, APC
Location: Costa Mesa
Posted on: November 22, 2022
A boutique healthcare law firm in Costa Mesa, CA is looking for
a motivated problem-solver to join its team as a Clinical Analyst.
The firm and its employees are dynamic, focused and fast-paced,
striving for excellence in all they do.
As a Clinical Analyst your job will be to support and ensure
performance, productivity, efficiency, and profitability of the
organization through accurately reviewing, validating and where
appropriate liquidating inventory. The Clinical Analyst is
responsible for review and assessment of clinical denials,
including review of patient medical information, patient account
documents, patient account history, Helton historical data,
provider contracts and regulations as appropriate.
The Clinical Analyst will draft focused, successful appeals, meet
and confer documents, IRO submissions, and when necessary, assist
with legal submissions on clinical issues. Will also communicate
with Hospital case management personnel to confirm facts, solicit
needed information and assist in managing clinical review program
and provide support to legal staff on patient accounts and
presentation of matters needed.
*This will be a hybrid position reporting to our office in Costa
Mesa three times per week.
- Prioritize voluminous claim review workload
- Validate claim status, claim liability and availability of
- Understand concepts of coverage, contract interpretation and
reimbursement methodologies needed to analyze claims
- Draft appeals, meet and confer documents, to resolve/overturn
clinical denial of patient accounts.
- Prepare and submit IRO submissions when mandated by
- Demonstrate understanding of relationships between health plans
- Have experience and an appetite in analytics and
- Research and analyze information including employing advanced
health care analytics and data science techniques to diagnose
reimbursement issues, opportunities assessment, claim trends,
develop solutions, and initiate appropriate claim resolution
strategies on accounts with clinical denial issues.
- Possess strong analytic and technical skills plus an ability to
translate complicated data into useable information
- Maintain quality and productivity standards as set by
- Influence others using a positive approach
- Work independently with minimal supervision
- Perform special projects as requested
- Ensure compliance with Health Insurance Portability and
- You are required to follow any other job-related instructions
and to perform any other job-related duties requested by your
supervisor on behalf of the Company
Qualifications / Skills
- Strong analytical, problem solving and research skills
- Excellent verbal and written communication skills
- Ability to multitask and thrive in a fast-paced work
- Strong organizational skills
- Highly detail oriented
- Team player
- Curious personality
- Applicants must be a RN or LVN with a current license in the
state of California
- 5+ years of Utilization / Case Management experience
Join the team now and you can have direct involvement with our
growth and make an impact to the future of healthcare.
*We offer a competitive salary and benefit package.
Keywords: Helton Law Group, APC, Costa Mesa , Clinical Analyst, Healthcare , Costa Mesa, California
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