Clinical Content Specialist (Payment Integrity)
BengaluruFull-time1–3 yrsPosted over a month ago
Junior content and media role at CoverSelf in Bengaluru. Needs 1–3 years and an MBBS, BDS or B.Pharm.
About the role
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.
What you'll do
- 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
What you need
- Medical coding
- Research
Good to have
- Six Sigma