Clinical Analyst

The Clinical Analyst will support provider outreach using healthcare workflows and provide clinical expertise. The position involves research, case resolution, reporting and cross functional collaboration to ensure accuracy and operational excellence. The role requires strong communication skills and analytical capabilities to manage client interactions through calls and email correspondence.
Key Responsibilities

• Investigate and resolve provider inquiries, including dismissals (e.g., incorrect CPT codes, ineligible beneficiary) and no-response cases.
• Conduct detailed case investigations and coordinate provider callbacks to share findings.
• Develop, update, and standardize process documentation to support scalability.•Identify gaps, errors, and improvement opportunities across billing, coding, pends, denials, and utilization review.
• Collaborate with operations, coding, QA, and client teams to ensure accurate and timely case resolution.
• Analyze data trends and provide insights to support decision-making.
• Handle inbound and outbound provider calls professionally to resolve concerns.
• Respond to emails promptly with clear and accurate communication.
• Participate in client/provider meetings, provider discussions, calibrations, andtroubleshooting sessions.
• Prepare dashboards, audit summaries, SOP updates, and RCA documentation.
• Ensure availability during business hours: 8:00 AM – 5 pm PM EST

Preferred Skills:

• Experience working with US payers or providers.
• Working knowledge of ICD, CPT, and HCPC nomenclature.
• Exposure to analytics platforms or BI tools.
• Ability to work effectively in a fast-paced, SLA-driven environment.

Experience with Amazon Connect or similar call center software
Required Skills Qualifications

• Preferred bachelor’s degree in Life Sciences, Nursing, Pharmacy, or a related healthcarediscipline.
• Strong understanding of the US healthcare ecosystem.
• Excellent verbal and written communication skills.
• Ability to manage calls and email interactions with internal and external stakeholders.
• Proficiency in Excel, reporting tools, and structured documentation.

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