RN Clinical Analyst
Overview
6 Degrees Health is a healthcare cost containment company dedicated to achieving superior results while prioritizing a best-in-class customer and member experience. We leverage both clinical expertise and innovative technology to deliver fair reimbursements and enhance payment accuracy. We are currently seeking a RN Clinical Analyst to join our fun, fast-paced environment.
- Organize and prioritize workload of the team
- 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
- 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
- Ensure that business decisions and processes are documented in a professional manner with due confidentiality
- Prepare the final review report following a clinical review and investigation; communicate the findings and initiates the corrective adjustments, if any
- 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
- Clinical review includes the evaluation of billing practices using clinical expertise to identify where providers are unbundling, up-coding, and demonstrating billing errors
- Offer technical support by continuous assessment and feedback concerning data quality and proper encoding of services
- Uphold the department’s goals and values, and contribute to its efficient development and growth
- Ensure that medical ethics and professionalism are maintained during the fulfilment of all tasks
- Conduct daily clinical claim reviews as assigned and within SLA’s
- 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
- Support clinical review with resolution and appeals
- Participate in continuing education to further understand industry billing practices and regulations
- Ensure that medical ethics and professionalism are maintained during the fulfilment of all tasks
Minimum Role Requirements
- Unencumbered RN license
- Bachelor of Science Degree in Nursing; Masters Degree preferred
- AAPC coding certification preferred
Essential Role Functions
- Must have the ability to read and understand various process flows and procedures
- Strong internal and external communication skills, both verbal and written
- Must be willing and able to work a 5-day schedule and additional hours beyond regularly scheduled shift to cover vacancies, if necessary
- Must be able to sit or stand for two hours at a time
- Must be able to operate computers and phones to support position requirements
- Strong Microsoft Office Skills are a must
- Medical, Dental, Vision and Other Outstanding Ancillary Benefits
- Training and Development Opportunities
- 10 Paid Holidays
- 401(k) Program
- Monthly Remote Work Stipend
- Employee Assistance and Educational Assistance Programs
- Unlimited Paid Time Off
- Calm App Premium Membership
The base salary range for this position is between $80,000.00 and $90,000.00, 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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