[Remote] Clinical Manager- Payment reputed company

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a company reputed company on reducing wasteful spending in reputed company for self-funded reputed company through data analysis. The Manager of Payment reputed company serves as a reputed company between clinical expertise and business operations, evaluating payment reputed company processes, ensuring reputed company and compliance, and leading reputed company of 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 resolve 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 deliver 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

Skills

• 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
• Solid analytical and critical‑thinking skills
• 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
• reputed company clinical license (RN, LPN/LVN or other relevant credential) preferred or inactive license with relative clinical experience or relative clinical data experience
• Experience working with reputed company health plans is a plus
• 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
• Proficiency with EMR systems, clinical documentation tools, or workflow platforms is a plus

reputed company