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# Clinical Systems Analyst

- **Company:** Resourcesoft, Inc.
- **Location:** United States
- **Experience:** Expert
- **Contract:** Permanent contract
- **Skills:** Databases, Reference Data, Software Repository
- **Published:** July 21, 2026
- **Apply:** https://www.dice.com/job-detail/4fb7d4ca-278d-4f02-8134-4e0b38181d85

## About the Role

* 10 or more years of experience in healthcare insurance operations, medical reviews, or program integrity.
 * Proficiency in ICD-10, CPT, and HCPCS medical coding translation methodologies.
 * Experience with clinical nursing operations and possessing an active Registered Nurse (RN) licensure.
 * Experience in a healthcare payer environment collaborating directly with software developers and programmers.
 * Experience with specialized medical coding software such as Optum Encoder and enterprise claims processing systems.
 * Experience in clinical policy remediation, medical necessity reviews, and patient chart assessments.
 * Excellent verbal and written communication skills.

## Description

* Conduct annual and quarterly clinical review updates of national coding change datasets from regulatory health authorities.
 * Formulate initial system impact analyses for newly introduced medical, procedural, and diagnostic codes.
 * Translate complex clinical policy and healthcare regulatory updates into systematic functional specifications for database systems.
 * Partner with application developers and software engineers to optimize state-level healthcare payer systems.
 * Oversee medical code repositories, reference data catalogs, and system business rules databases.
 * Evaluate patient records against established clinical criteria to determine medical necessity and payment eligibility.
 * Coordinate interdisciplinary project meetings to communicate technical code revisions and operational changes to stakeholders.


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