Clinical Business Analyst - REMOTE job in Boston, USA

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Last Name*

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First Name*

Last Name*

Email*

Phone Number*

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Are you an employer or a jobseeker?*

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First Name*

Last Name*

Email*

Phone Number*

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Are you an employer or a jobseeker?*

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Job type: Permanent

Discipline: Clinical Trial Assistant (CTA), Clinical Research Associate (CRA), Clinical Scientist

Location: United States

This vacancy has now expired. Please see similar roles below...

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.

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