Clinical Tool Specialist

The following requirements are essential:

* Physician/MBBS degree as a clinical qualification required. Medical degree with a minimum of 5 years of post-qualification experience.
* Private health care experience would be an advantage.
* Qualifications or training in Health informatics, clinical coding or Health Administration would be very helpful.

Core Responsibilities :

* Evaluate and recommend improvements to the current clinical tools include but not limited to diagnosis related groupers, disease episode groupers, patient risk scores, disease staging tools.
* Evaluate and recommend improvements for relative indices such as risks scores, disease burden index and case mix that support our clinical tools.
* Understand the final usage of the tools and recommend relevant insights for clinical tool evolution.
* Provide clinical support in the analysis of claims data to derive actionable clinical insights.
* Participate in the application of the tools in various business processes and engage with Customers to discuss the effective usage of clinical tools.
* Create and assist in the development of Clinical Pathways for a range of products such as Condition Management, Hospital Optimization, Palliative Care, etc.
* Review the clinical appropriateness of product designers.
* Supporting clinical coding teams in the creation, update, and maintenance of clinical classifications
* Research and develop/implement various clinical terminologies and ontologies (such as SNOMED-CT, LOINC, WHO ICD-10, ICD10CM, ICD11, CPT, ATC etc.) for integration and enhancement for our clinical tooling

Behavioral Skills

What you need to be successful

* Exceptional communication skills across a wide range of stakeholders
* Ability to work cohesively in a team environment while balancing multiple priorities.
* High level of attention to detail, resilience, enthusiasm, energy, and drive
* Positive, can-do attitude focused on continuous improvement.
* Ability to take feedback and constructive criticism to drive improved delivery.
* Rigorous ability to problem-solve and optimize the environment.
* Excellent coordination skills

Technical understanding Required

A working understanding of the clinical data used in healthcare is optimal as data forms the basis of our products, as such the following core understandings are required

* Knowledge of healthcare specific data/ health Insurance claims is a must.
* Reasonable competence in use of Microsoft Office suite of tools especially Excel, Access, and PowerPoint
* Knowledge of patient health management, provider profiling, healthcare reporting, and other key healthcare technologies, etc.
* Knowledge of clinical tools and coding including coders, groupers, cross walks, and classifications
* Jira and Confluence Knowledge
* Agile ways of working
* Understanding of Tech Products Lifecycle
* Strong DRG and Clinical Coding foundation
* Databricks knowledge
* Experience in clinical reviews for output sanity checks
* Experience in Closed File Review for missed recovery/ prevent FWA opportunities.
* Experience in working with Health Tech Team (Project Manager, Data Scientists, Data Analysts)

The Below Understandings Are Advantageous However Not Compulsory

* SQL, python, and advanced excel
* Understanding of advanced statistics, risk adjustment and health outcome indices and metrics
* Knowledge of usage of data science in the healthcare space
* Experience in Microsoft Azure (Databricks, Synapse, Data Factory, etc.)

Must Haves :
– Certified medical coder with Certification(s) from AAPC or AHIMA including but not limited to CPC, CRC, CCS, or CCS-P.
– Exp in international coding standards such as ICD9/10PCS, ICHI, Current Procedural Terminology (CPT), International Classification of Disease 10th Edition -Clinical Modification (ICD-10-CM), and Health Care Procedure Coding System (HCPCS), Anatomical Therapeutic Chemical (ATC), RxNorm, Global Medical Device Nomenclature (GMDN)
– Well versed in Risk Adjustment tools like (HCC), diagnosis related groupers, disease episode groupers, patient risk scores, disease staging tools, etc.- Preferred

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