Clinical Content specialist – 1-3 yrs Exp – Upto 7L CTC – Bengaluru

Angel and Genie; Bengaluru; On-site; INR 600,000 - 1,200,000; Full time

Benefits offered by this job

Best-in-class compensation

Health insurance for Family

Personal Accident Insurance

Friendly and Flexible Leave Policy

Certification and Course Reimbursement

Medical Coding CEUs and Membership Ren

Health checkup

Job summary

Angel and Genie is seeking a Clinical Content Specialist to develop and maintain payment integrity rules and code edits for automated claims validation. You will translate clinical guidelines and payer policies into business logic and rule frameworks, enabling efficient, accurate claim processing.

The role emphasizes policy development, rule engines, and collaboration with cross-functional teams in a fast-paced environment. Prior experience in CMS guidelines and coding standards is essential.

Qualifications

• Must have experience in Payment Integrity, clinical content development or policy building.
• Ability to convert clinical guidelines into logical, rule-based systems.
• Strong knowledge of CMS policies, payer guidelines, and coding standards.
• Experience with CPT, ICD, LCD/NCD, PTP, NCCI, edits, modifiers and Medicare schedules.

Responsibilities

• Develop and maintain payment integrity rules, edits, and policies.
• Design clinical logic and algorithms for claims validation.
• Translate CMS guidelines into business rules for automated checks.
• Build code edit solutions to detect incorrect payments.
• Conduct policy research and update policy libraries and rule frameworks.
• Support semi-automated claims review systems.

Skills

Payment integrity

Clinical policy development

CMS guidelines

Code edit logic

Analytical thinking

Communication skills

Problem-solving

Learning mindset

Education

Medical degree (MBBS, etc)

Nursing degree

Pharmacist degree

Life science degree

Job description

Position Overview:

This role focuses on developing clinical content, payment integrity rules, and code edit solutions. The Clinical Content Specialist will translate clinical guidelines and payer policies into business logic, algorithms, and rule frameworks for automated claims validation.

Specialty Expertise:

Payment Integrity

Clinical Coding & Policy Development

Claims Prepayment Review

Data Mining & Content Development

Key Responsibilities:

Develop and maintain payment integrity rules, edits, and policie

Design clinical logic & algorithms for claims validation

Translate CMS guidelines → business rules

Build code edit solutions to detect incorrect payments

Conduct research on medical policies and reimbursement methodologies

Enhance and maintain policy libraries and rule frameworks

Support semi-automated claims review systems

Requirements:

Strong experience in Payment Integrity / Clinical Content / Policy building

Ability to convert clinical guidelines into logical rules

Knowledge of CMS policies, payer guidelines, and coding standards

Strong analytical and problem-solving mindset

• Solid understanding of medical coding & billing methodologies and guidelines, including CPT, ICD, LCD/NCD, PTP, NCCI, edits, modifiers, Medicare Physician fee schedule, and coding conventions.
• Proficiency in data collection, analysis, and deriving actionable insights from CMS medical policies, Medicaid Provider Manuals and other Medical publications.
• Translate industry references into actionable business logic to support new rules and policy enhancements.
• Strong understanding of claim forms like UB-04/CMS 1450 and CMS 1500
• Collaborate effectively across teams while managing multiple priorities
• Ability to thrive in a fast-paced, dynamic environment with minimal supervision.
• Demonstrated mindset for continuous learning and improvement and apply insights to policy development, refinement and maintenance.
• Strong stakeholder management, interpersonal, and leadership skills.
• Solution-focused, motivated, entrepreneurial spirit with a strong sense of ownership.
• Clear and effective communication.
• Strong attention to accuracy and detail in all deliverables

Qualifications

Education & Certification (one of the following required):

• Medical Degree (e.g., MBBS, BDS, BPT, BAMS etc)
• Nursing: Bachelor/Master of Science in Nursing
• Pharmacist Degree (B.Pharm, M.Pharm or PharmD)
• Life Science -Bachelor/Master

Certification Requirements:

• Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.
• Additional weightage will be given for AAPC specialty coding certifications.
• Lean Six Sigma certification and practical application experience are preferred.

Experience:

• 1-3 years experience
• Experience in policy development, rule engines, or PI companies

Key Skills:

• Payment Integrity domain knowledge
• Clinical policy & content development
• CMS / Medicare / Medicaid guidelines
• Code edit logic (NCCI, LCD/NCD)
• Strong analytical & interpretation skills
• Excellent verbal & written communication skills.
• Excellent Interpretation and articulation skills
• Strong analytical, critical thinking, and problem-solving skills
• Willingness to learn new products and tools

Work Details:

• Location: Basavanagudi,Bangalore
• Mode: Work from Office

Benefits:

• Best-in-class compensation
• Health insurance for Family
• Personal Accident Insurance
• Friendly and Flexible Leave Policy
• Certification and Course Reimbursement
• Medical Coding CEUs and Membership Renewals
• Health checkup
• And many more!