Clinical Content Analyst/Developer

Job Description:
The Clinical Content Analyst/Developer researches, analyzes and creates clinical drug, medication and high cost injectables content for the Specialty pharmacy rules for Change Healthcare’s Clinical Claims Management (CCM).


The CCM Product Line is a fast-paced environment with contractually driven quarterly deliverables. The CCM products are utilized by payer organizations to augment claims management systems, by electronically auditing medical claims, for accurate processing of both professional and facility claims. The role of the Analyst/Developer is to provide comprehensive and in-depth research, analysis and clinical drug, medication and high cost injectables content development of new and revised clinical drug and medication indications to be offered in our Specialty Pharmacy rules, to expand the CCM suite of offerings. The content updates are identified by reviewing clinical sources such as but not limited to the National Comprehensive Cancer Network, Clinical Pharmacology, Federal Drug Administration and other sources and/or compendium as required.



Minimum Qualifications:
American Academy of Professional Coders CPC certification or American Health Information Management Association CCS-P certification is required, prior to hire date. Registered Nurse (U.S. or Philippine) Two years or more relevant healthcare experience as a medical coder, medical biller, medical claims processor, claims reviewer, bill reviewer or medical chart auditor/abstractor is required, with at least one year of recent relevant experience. Relevant experience with inpatient facility, outpatient facility and professional claims is a plus. Specialized Knowledge/Skills – National medical coding certification CPC or CCS-P is required. Must possess current, strong working knowledge of CPT codes & guidelines, HCPCS codes & guidelines, current ICD-10-CM codes & guidelines as well as current medical coding and billing guideline expertise and experience, with topics to include but not limited to Medicare Physician Fee Schedule DB, etc. Results driven individual. Ability to be self-directed daily, with high level of integrity and to successfully manage multiple priorities with deliverables completed on time and with high quality. Ability to present confidently in large group settings. Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; Outlook. Ability to use Access at a beginner level is a plus.