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Clinical Business Analyst - REMOTE

Employer
Proclinical Staffing
Location
Homeworking
Salary
Highly Competitive Salary
Start date
20 Mar 2023
Closing date
3 Apr 2023

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Job Details

Proclinical is seeking a remote Clinical Business Analyst for a leading health service organization.

Must be eligible to work or be a citizen in the US.

Job Responsibility:

  • Develop business rules from medical and payment policies including rationale for interpretation, supporting evidence, and documentation.
  • CLO Reporting
  • PRISM implementation/integration
  • CLO Data Analytics
  • Create test cases to ensure the proper configuration and implementation of business rules into the Claims Editor
  • Determine coverage overlaps with government programs.

Skills and Requirements:

  • Medical Assistant and/or Nursing a plus
  • Knowledge of and experience with laboratory medical coding rules and regulations, compliance, reimbursement, bundling issues.
  • Experience with data analysis tools
  • Experience with Centers for Medicare & Medicaid Services (CMS) and industry standard billing, compliance, and reimbursement methodologies.
  • Familiarity with government programs (Medicare, Medicaid, ACA Marketplace, etc.)
  • Experience with developing logic associated claims editing
  • Familiarity with commercial payor medical policies
  • Biology, chemistry, medicine, nursing, medical technology, or related field of education
  • Laboratory Billing Understanding and reimbursement practices
  • Certified Medical Coder: RHIT, CPC, CCS or similar
  • Clinical coding experience with a background of ICD-10, CPT, and HCPCS coding principles
  • Bachelor of Science or Arts or equivalent
  • High attention to detail and documentation
  • Independent, capable of decision making with limited information

If you are having difficulty in applying or if you have any questions, please contact George Watson at (+1) 929-388-1650 or g.watson@proclinical.com.

Proclinical is a specialist employment agency and recruitment business, providing job opportunities within major pharmaceutical, biopharmaceutical, biotechnology, and medical device companies.

Proclinical Staffing is an equal opportunity employer.

#LI-GW1

Company

At ProClinical we have one aim: to support life science companies in the many challenges they face while combatting unmet medical need worldwide.

Ageing populations, rare diseases, epidemics and the millions of patients without access to medication are just a few of the pressing issues that life science companies contend with. The industry is under increasing pressure to develop new and innovative ways to save and improve patients’ lives. 

ProClinical’s mission is to support their work by connecting life science companies with the highly skilled professionals they need to continue innovating. 

Internal recruitment and HR teams often struggle to continuously source skilled, experienced professionals to fill highly-specialised and niche roles. ProClinical combines a deep understanding of the industry with extensive candidate networks to provide both a technical and cultural fit for our life science partners.

 

Company info
Website
Telephone
0800 988 4437
Location
Eldon House
Eldon Street
London
EC2M 7LS
United Kingdom

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