Complex Clinical Claims Analyst

Review facility claims to validate the appropriateness of billed charges against medical records and client policies. Apply clinical and coding guidelines to assess level of care, experimental/investigation services, medication charges (including potential off-label use), and Do Not Bill Events/HACs. Research and develop claim-review resources, provide evidence to partners, support sales initiatives, manage appeal language for response letters, and help with staff training while meeting productivity and audit-accuracy targets.