Clinical Content Specialist (Payment Integrity)
CoverSelfJayanagar, BangalorePosted a month agoA free account shows the apply link for every role and matches you to the ones that fit your resume.
About the role
CoverSelf provides a cloud-native platform that helps US healthcare payers prevent inaccurate claims and payments. The specialist develops clinical content, payment integrity rules and code edits for automated claims validation.
What you'll do
- Develop and maintain payment integrity rules, edits and policies
- Design clinical logic and algorithms for claims validation
- Translate CMS guidelines and payer policies into business rules
- Research medical policies and reimbursement methodologies
- Maintain policy libraries and rule frameworks
- Support semi-automated claims review systems
Skills
Must have
- Payment integrity
- Clinical policy development
- Medical coding
- Medical billing
- Cms guidelines
- Medicare guidelines
- Medicaid guidelines
- Code edit logic
- Claims validation
- Policy development
Nice to have
- Lean six sigma
Who it's for
- Education
- Bachelor's degree
- Degree
- medicine, nursing, pharmacy, life science
- Experience
- 1 to 3 years
- Domain
- healthcare payment integrity
About CoverSelf
CoverSelf has 4 open roles in Bangalore, at CoverSelf Bengaluru. See every CoverSelf role.
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