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Clinical Analyst

Company: Helton Law Group, APC
Location: Costa Mesa
Posted on: November 22, 2022

Job Description:

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.
Job Responsibilities

  • Prioritize voluminous claim review workload
  • Validate claim status, claim liability and availability of coverage
  • 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 contract
  • Demonstrate understanding of relationships between health plans and providers
  • Have experience and an appetite in analytics and quantitative/qualitative/data analysis
  • 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 Management
  • Influence others using a positive approach
  • Work independently with minimal supervision
  • Perform special projects as requested
  • Ensure compliance with Health Insurance Portability and Accountability Act
  • 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 environment
    • Strong organizational skills
    • Highly detail oriented
    • Team player
    • Curious personality
      Experience Requirements
      • 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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