A Systems Analyst helps businesses and organizations to plan and build computer systems. Reviews the information processing needs of the organization, plans and sets up computer networks and software, and tests systems for accuracy, efficiency and ease of use.
The CSI Clinical Analyst is a registered professional nurse with knowledge and expertise in process analysis, clinical outcome data analysis, utilization management, utilization of information systems and regulatory requirements. The CSI Clinical Analyst is knowledgeable regarding changes in care delivery and their impact on third party reimbursement. The CSI Clinical Analyst's role is to support clinical and financial integration across the continuum and while insuring the organizations clinical and financial integrity. The CSI Clinical Analyst works collaboratively with staff from Denials Management, Corporate Compliance, revenue cycle, Integrated Care Management (ICM), physicians, and other internal and external customers. The CSI Clinical Analyst is responsible for ensuring the appropriate use of hospital resources including appropriate status assignment, meeting third party payor clinical review requirements, and working with the ICM team, physicians, and Denials Management team to prevent denials. The CSI Clinical Analyst identifies trends in inappropriate application or utilization of services and potential lost reimbursement for these services. The CSI Clinical Analyst is knowledgeable of third-party payor contracts, Medicare/Medicaid guidelines, and other regulations impacting the approval or denial of services.
QUALIFICATIONS
Education:
Bachelor's of Nursing degree
Licensure/Certification/Registration:
Registered nurse with valid Ohio license. Certification in area of clinical specialty preferred
Experience Required:
3 - 5 years of job-related experience Prior job title or occupational experience: Case management, utilization review, clinical nurse Preferred experience: Knowledge of hospital reimbursement, third party billing, government rules and regulations Other experience requirements: Minimum 1 year experience with utilization management, case management and knowledge of InterQual and
MCG OR 5
years' relevant adult clinical experience. Process improvement experience. Knowledge/Skills Personal computer skills required, including use of Microsoft Word, Microsoft Excel, EPIC Experience in gathering information, monitoring indicators, and feedback mechanisms is required. Strong interpersonal skills required Ability to research, evaluate information, analyze problems and make appropriate recommendations required Demonstrated conflict resolution skills required Assertive communication skills required
