Clinical Solutions Analyst
The Clinical Solutions Analyst serves as a key partner in supporting healthcare clients through operational analysis, process improvement, and implementation of utilization review and clinical revenue cycle solutions. This role works closely with internal leaders and client stakeholders to identify opportunities, analyze workflows, develop recommendations, and support operational initiatives that improve quality, efficiency, compliance, and financial performance.
The ideal candidate has a strong understanding of healthcare operations and enjoys solving complex problems through data analysis, collaboration, and process improvement.
Key Responsibilities
- Analyze client workflows related to utilization review, case management, clinical documentation improvement (CDI), coding, denials management, and revenue cycle operations.
- Gather and document business requirements from internal and external stakeholders.
- Evaluate operational processes and identify opportunities to improve efficiency, quality, turnaround times, and financial outcomes.
- Develop recommendations and implementation plans based on operational findings.
- Assist with onboarding new clients and implementing HURC service offerings.
- Create process maps, workflow documentation, training materials, and operational guides.
- Support client meetings by preparing reports, dashboards, presentations, and action plans.
- Monitor operational metrics, identify trends, and communicate findings to leadership and clients.
- Collaborate with clinical, coding, physician advisor, and operations teams to ensure consistent delivery of services.
- Assist with quality initiatives, audits, and continuous improvement projects.
- Utilize Microsoft Excel and reporting tools to analyze operational and performance data.
- Participate in client presentations and serve as a trusted operational resource.
- Stay current on regulatory requirements, payer guidelines, and healthcare industry best practices.
Qualifications
Bachelor's degree (Health Information Management, or a related field.
- 2-3 years of healthcare operations experience.
- 2-3 years of project management experience within healthcare, managed care, revenue cycle, utilization management, or healthcare consulting.
- Experience in one or more of the following:
- Utilization Review
- Case Management
- Clinical Documentation Improvement (CDI)
- Medical Coding
- Revenue Cycle
- Managed Care
- Denials Management
- Strong analytical and problem-solving skills.
- Excellent written and verbal communication skills.
- Advanced Microsoft Excel skills.
- Ability to manage multiple priorities in a fast-paced consulting environment.
- Strong organizational and project management skills.
- Comfortable working directly with healthcare executives and clinical leaders.
