SmartLight Analytics

About SmartLight Analytics

We are seeking a Clinical Medical Review Analyst who would like to work on a contract basis. The candidate selected will be responsible for performing analysis of commercial healthcare claims. Responsibilities: Performs comprehensive coding analysis and clinical evaluation of inpatient and outpatient healthcare claims Applies appropriate clinical/medical review guidelines, policies, and rules Documents all findings referencing the appropriate policies and rules Generates standard reports articulating findings Coordinates with appropriate staff at a healthcare insurance company Suggests ideas that may improve audit workflows Interface with and support the Medical Director Qualifications: A RN with 5+ years experience performing utilization review, case management, claims auditing or payment integrity review for a healthcare insurance company Requires current certification as a Certified Professional Coder (AAPC or AHIMA) or willing to obtain within six months of the hire date RN preferred, >3 years of clinical practice Knowledge of healthcare payment methodologies Awareness of healthcare claims adjudication process, particularly payment rules PC proficiency to include Microsoft Word and Excel Strong problem solving, analytical, and critical thinking skills Excellent written and verbal communication skills Self-motivated Self-starter Ability to thrive in a changing environment with strong organizational and prioritization skills This is a remote position but may require some travel. The position will start with 10-15 hours per week and has potential to convert to full-time. Job Type: Contract Hourly Rate: $35.00- $45.00 Job Type: Part-time Salary: $35.00 to $45.00 /hour Work Location: Fully Remote Typical start time: 9AM Typical end time: 5PM This Job Is Ideal for Someone Who Is: Dependable -- more reliable than spontaneous Adaptable/flexible -- enjoys doing work that requires frequent shifts in direction Detail-oriented -- would rather focus on the details of work than the bigger picture Achievement-oriented -- enjoys taking on challenges, even if they might fail Innovative -- prefers working in unconventional ways or on tasks that require creativity High stress tolerance -- thrives in a high-pressure environment Schedule: Monday to Friday

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