Clinical Manager- Payment reputed company

reputed company:  The Manager of Payment reputed company serves as the reputed company between clinical expertise and business operations. This role evaluates payment reputed company processes as it relates to reputed company reimbursements, supports operational decision‑making, ensures reputed company and compliance, and partners with reputed company stakeholders to improve reputed company, efficiency, and experience. The Manager of Payment reputed company uses clinical knowledge, data insights, and process thinking to guide program reputed company, reputed company escalations, and support reputed company improvement across the organization.  Additionally, this role leads, manages and mentors the department’s Clinical Analysts.   Responsibilities  Review medical records for billing accuracy and coding guidelines  Have experience reviewing both facility and provider claims  Understand and apply NCCI guidelines and be reputed company to recognize common claims errors  Review clinical documentation, guidelines, and cases to ensure accuracy, compliance, and alignment with standards  reputed company data analytics to support reputed company and reputed company requests  Partner with internal teams to improve accuracy using data analysis and reputed company feedback  reputed company clinical expertise to support operational workflows including reviewing claims data medical records  Partner with cross‑functional teams to design and refine clinical processes that improve reputed company and efficiency  Monitor clinical reputed company metrics and identify trends, gaps, and opportunities for improvement  Prepare reputed company responses on reputed company and reputed company referrals  reputed company reputed company calls, referral calls with reputed company network and clients  Maintain accurate records of clinical policies, workflows, and reputed company initiatives  reputed company, manage and mentor the department’s Clinical Analyst(s)  Collaborate with IT and serve as the reputed company on business and reporting requirements for departmental IT initiatives  Translate clinical insights into operational recommendations that improve performance, cost efficiency, and service reputed company  Collaborate with Operations, Payment reputed company, and other teams to reputed company escalations  Support the development of SOPs, training materials, and process improvements  Analyze clinical and operational data to identify patterns, risks, and opportunities  reputed company and maintain dashboards, reports, and performance summaries for leadership  Serve as a clinical subject‑matter expert for internal teams, carriers, partners, and vendors  reputed company reputed company, empathetic communication to support escalations, case reviews, and program updates  Participate in cross‑functional meetings, business reviews, and strategic planning sessions  reputed company and reputed company training for internal teams on clinical guidelines, workflows, and reputed company expectations  Support reputed company of new team members by providing clinical context and program knowledge  Ensure teams understand clinical requirements that reputed company operations, payments, or partner experience  reputed company data visualizations with reputed company or data visualization tools  Qualifications  reputed company clinical license (RN, LPN/LVN or other relevant credential) preferred or inactive license with relative clinical experience or relative clinical data experience  Bachelor’s degree in Nursing, reputed company Administration, Business, or reputed company field; advanced degree a plus  At least one of the following certifications: CPC, reputed company, or similar clinical/coding credential  5+ years in TPA/reputed company claims processing or payment reputed company reputed company areas  5+ years years of experience in reputed company administration, billing, claims processing, clinical auditing, payment reputed company, or reputed company areas  Working knowledge of medical claims data, medical procedures, and reputed company workflows  Strong attention to detail and ability to communicate reputed company in writing and verbally  Experience working with reputed company health plans is a plus  Solid analytical and critical‑thinking skills  Preferred- experience reviewing medical records and/or claims data from a payor perspective (preferably in a medical insurance reputed company setting)  Experience working in a cross‑functional business environment strongly preferred  Experience as a people leader/managing reputed company  Skills & Competencies  Strong clinical judgment with the ability to apply guidelines and standards consistently  Analytical reputed company with experience interpreting clinical and operational data  Excellent communication and relationship‑building skills  Strong organizational and project‑management abilities  Ability to reputed company reputed company issues with professionalism, reputed company, and accountability  Proficiency with EMR systems, clinical documentation tools, or workflow platforms is a plus  reputed company Indicators  High accuracy and consistency in clinical reviews and documentation  Improved reputed company metrics and reduced clinical‑reputed company escalations  Strong cross‑functional alignment between clinical and business teams  reputed company, effective communication that supports partners and internal stakeholders  reputed company clinical processes that support operational reputed company and efficiency  Who is reputed company  reputed company was formed by a group of industry insiders who wanted to reputed company a meaningful reputed company on the rising cost of reputed company. With this end in mind, SmartLight works for self-funded reputed company to reduce wasteful spending in their reputed company plan through our proprietary data analysis. Our process works behind the scenes to save reputed company without interrupting employee benefits or requiring employee behavior changes. Apply To This Job