IT Clinical Analyst


Resourcesoft, Inc.
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Job Details
Skills
- ICD-10
- CPT
- HCPCS
- MMIS
- Medical Coding
- Clinical Analysis
- Registered Nurse
- CPC
- CCS
- Claims Processing
- Business Rules
- Optum Encoder
- Payor Systems
- Healthcare IT
- Program Integrity
- Medical Necessity
Summary
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5 or more years of experience in clinical analysis and medical coding within a healthcare payor environment.
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Proficiency in ICD-10, CPT, and HCPCS coding methodologies as a licensed RN and CPC or CCS.
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Experience with medical coding software such as Optum Encoder and automated claims adjudication platforms.
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Experience in translating clinical policy into structured business rules and technical functional specifications.
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Experience with medical necessity reviews, program integrity audits, and payor appeals processing.
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Experience with CMS annual update cycles and maintaining requirements in documentation repositories.
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Excellent verbal and written communication skills.
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Research and implement annual and quarterly medical code updates from federal regulatory sources.
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Architect clinical business rules and functional requirements for technology-driven claims processing.
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Lead technical analysis of code scope changes and their impact on existing adjudication logic.
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Maintain technical repositories for business rules, requirement models, and process documentation.
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Provide clinical subject matter expertise for the design and enhancement of enterprise management information systems.
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Evaluate patient records against established clinical criteria to determine medical necessity and system alignment.
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Collaborate with software developers and programmers to remediate policy gaps within payor platforms.
- Dice Id: 10117734
- Position Id: 21253-27990-
- Posted 1 hour ago
Company Info
About Resourcesoft, Inc.
Founded in 1999, Resourcesoft, Inc. is a leading Technology Consulting and Professional Services organization. Headquartered in Marlborough, MA, the company serves the technology needs of its clients nationwide. Resourcesoft has often been recognized by prominent rating agencies for its exemplary growth and stability. With over two decades of industry experience, the company has evolved as a front runner in enabling project optimization. We partner with leading organizations to provide technology solutions within the financial, insurance, education, government, publishing, healthcare and pharmaceutical domains. We take pride in mentoring a workforce that is well positioned to respond to the emerging IT trends and needs. With the employees at the crux of every business endeavor, our success is driven by our expertise in pairing the right talent with the best jobs in the technology sector. We forge long term, personalized relationships with our employees to advance their career to the next level. We engage them in technology centric client projects that provide opportunities for them to evolve, innovate and deliver world class products and services. Our career opportunities offer challenging assignments and exposure to emerging and cutting edge technologies. We are committed to providing our employees with the tools necessary to accelerate their career progression, while maintaining a healthy, work-life balance. We are deeply committed to providing a workplace ambience that is both challenging and fulfilling.
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