Clinical Content Specialist (Payment Integrity & Policy) – Bangalore – 3-15 yrs Exp

Angel-and-Genie; Bengaluru; Vor Ort; INR 800.000 - 1.200.000; Vollzeit

Benefits dieser Stelle

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

Zusammenfassung

Angel-and-Genie in Bengaluru is hiring a Clinical Content Specialist to develop clinical content and payment integrity rules. The role demands strong analytical skills and the ability to translate clinical guidelines into business logic.

Ideal candidates will possess a medical degree or equivalent, and have proficiency in CMS guidelines and coding standards. The position offers competitive benefits, including health insurance and flexible leave policies.

Qualifikationen

• 3+ years experience for Analyst, 5+ years for TL, 10+ for Manager, 13+ for Senior Manager.
• Knowledge of CMS policies, payer guidelines, and coding standards is required.
• Ability to collaborate effectively across teams while managing multiple priorities.

Aufgaben

• Develop and maintain payment integrity rules, edits, and policies.
• Design clinical logic & algorithms for claims validation.
• Conduct research on medical policies and reimbursement methodologies.

Kenntnisse

Payment Integrity domain knowledge

Strong analytical & interpretation skills

Excellent verbal & written communication skills

Clinical policy & content development

Code edit logic

Ausbildung

Medical Degree (e.g., MBBS, BDS, BPT, BAMS)

Nursing: Bachelor/Master of Science in Nursing

Pharmacist Degree (B.Pharm, M.Pharm or PharmD)

Life Science -Bachelor/Master

Jobbeschreibung

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 policies
• Design clinical logic & algorithms for claims validation
• Translate CMS guidelines to 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

• 3+ years experience for Analyst
• 5+ years experience for TL
• 10+ Years for Manager
• 13+ years for Senior Manager
• 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:Jayanagar, 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!