Clinical Content Specialist
Clinical Content Specialist
CoverSelf
Job description
Interested in a job in clinical policy creation and claims validation? Explore the Clinical Content Specialist job at CoverSelf in Bangalore.
Company Profile
CoverSelf is a healthcare technology business that helps US healthcare payers with a cloud-native, configurable platform. Its technologies are meant to detect errors in healthcare claims and payments while helping to minimise administrative complexity and cost. The startup has received backing from BeeNext, 3One4 Capital and Z21 Ventures.
Overview of the Job
This Bangalore-based position will focus on creating clinical content and payment integrity solutions for claims validation. The Clinical Content Specialist will transform clinical recommendations and payer policies into logic rules, algorithms and code modifications. The role also includes research on medical policies and reimbursement methodologies, as well as managing policy libraries and supporting semi-automated claims review systems.
Principal Responsibilities
Develop and implement payment integrity rules, changes and associated policies.
Develop clinical logic and algorithms to assist in claims validation.
Translate CMS recommendations and other clinical needs into business standards.
Create code-edit solutions to help identify inappropriate healthcare payments.
Research medical policies, reimbursement systems and related healthcare information.
Improve and support clinical policy libraries and rule engines.
Support semi-automated systems used for claims review.
Pull valuable information from CMS medical policies, Medicaid provider guides and other medical publications.
Based on industry references, build new regulations and update existing regulatory frameworks.
Educational Qualification
Candidates must possess the following educational qualifications:
Medical Degree like MBBS, BDS, BPT, BAMS or any other Medical Degree.
Bachelor’s or Master’s in Nursing.
PharmD, M.Pharm or B.Pharm.
Degree in Life Sciences (BSc or MSc) .
Skills Needed
Understanding of the Payment Integrity domain.
Knowledge of clinical policy and content creation.
Knowledge of CMS, Medicare & Medicaid guidelines.
Knowledge of medical coding and billing topics such as CPT, ICD, LCD/NCD, PTP, NCCI, modifiers and coding rules.
Translates healthcare guidelines and industrial references into sound business rules.
Knowledge of claim forms such as UB-04/CMS 1450 and CMS 1500.
Strong analytical, interpretive and critical thinking skills.
Good problem-solving skills.
Excellent verbal and written communication skills.
Good skills of interpretation and articulation.
Strong stakeholder management skills, people and leadership skills.
Attention to detail and precision.
Desire to learn new items and tools.
Ability to operate independently in a fast paced setting.
AAPC specialist coding certifications are preferred as well.
Preferred: Lean Six Sigma Certification and hands-on experience.
Salary Structure
The estimated compensation for a Clinical Content Specialist in this CoverSelf role in Bengaluru is ₹6 Lakhs-10 Lakhs per year.
Career Development
This work can help people gain experience in converting clinical information into business rules and analytical solutions and help them advance their skills in healthcare payment integrity, clinical policy creation, medical coding and claims validation.
Application
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Education
Bachelor's Degree
Key Skills
Market insights & trends
Salary Insights
The amount of money that gets paid can be different depending on how they have been working, where they live and what kind of job they are doing. Some places pay more than others. Most good jobs include extra money for doing a good job, health insurance and flexible hours. Companies pay high salary to make sure they can get the people they want.
Hiring Trends
The number of jobs for this profile is going up every year. Hospitals and other healthcare companies are looking for people who're good, at their job and can also figure out new problems. They want who can do the work and also think on their feet to deal with the challenges of working in healthcare today.