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.

Key Responsibilities:
Develop and maintain payment integrity rules, edits, and policies
Translate Healthcare Payer guidelines ↠business rules
Build code edit solutions to detect incorrect payments
Conduct research on medical policies and reimbursement methodologies

Requirements:
Passionate about working in the clinical domain, with a focus on learning and growth
Strong foundation in clinical concepts, Ability to convert clinical guidelines into logical rules
Demonstrated experience in research work, college thesis, or complex case study analysis
Strong research mindset with the ability to interpret clinical and medical literature
Excellent communication, articulation, and interpretation skills
Ability to translate complex clinical information into explicit and structured insights
Sound clinical knowledge with attention to detail and accuracy
Support the configuration of payment integrity rules/solutions based on business requirements.




Assist with testing configured rules and validating results to ensure expected outcomes.

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.

Experience:

Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.

Key Skills:
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 recent products and tools

Work Details:
Location: Jayanagar, Bangalore
Mode: Work from Office

Perks:
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!

📌 Junior Payment Integrity Analyst Medical Coding Bengaluru
🏢 Angel and Genie
📍 Bengaluru