Complex Clinical Claims Analyst (Healthcare)

TL;DR

Complex Clinical Claims Analyst (Healthcare): Reviewing facility claims to analyze the appropriateness of billed charges against medical records with an accent on clinical and coding guidelines. Focus on researching complex claims, identifying experimental services, and ensuring payment integrity within an AI-powered healthcare platform.

Location: Must be based in the US

Salary: $100,000 - $110,000

Company

hirify.global is a healthcare intelligence company providing an AI-powered platform to maximize financial outcomes and drive down costs for health plans.

What you will do

• Perform detailed clinical and coding reviews of facility claims, including itemized statements and medical records.
• Research medical policies and clinical guidelines to identify experimental or investigation charges.
• Analyze medication charges and potential off-label use to ensure billing accuracy.
• Provide evidence-based support for industry standards and review stances to internal and external partners.
• Contribute as a subject matter expert for new client initiatives and sales calls.
• Collaborate on staff training processes and the development of complex claims review content.

Requirements

• Bachelor of Science in Nursing, RN, LPN, or LVN required.
• Minimum 2+ years of experience in complex claims or itemized bill review.
• Minimum 3+ years of experience in healthcare billing and coding.
• Must be based in the US.
• Proven success working in a remote environment.
• Advanced proficiency in Microsoft Office Suite.

Culture & Benefits

• Comprehensive health, vision, and dental coverage.
• 401(k) plan participation with company match.
• Paid Time Off, paid holidays, and volunteer days.
• Tuition reimbursement program.
• Company-paid life insurance, short-term disability, and parental leave.