09/05 Neha Khaladkar
Associate Manager at Hexagon Executive Search

Views:260 Applications:11 Rec. Actions:Recruiter Actions:1

Clinical Specialist - Hospital - GNM (3-10 yrs)

Pune Job Code: 6311


Clinical Specialist

What You- ll Be Doing:

- Review clinical accuracy and validity of clinical rules algorithms.

- Surveillance of US medical society best practice guidelines (i.e., USPSTF, ADA, ACOG, ACC, etc) relating to clinical quality algorithms.

- Provide clinical context for maintenance and creation of code sets relating to US clinical quality measures (ICD10, CPT, LOINC, etc).

- Researching and reviewing appropriate clinical algorithms for various business & clinical use cases to support rules construction.

- Assist with quality assurance related to rule engine algorithms including performance and reporting to assess and quantify the impact of upstream data issues.

- Support Clinical Informatics team with creation/documentationand maintenance of technical specifications for algorithms that describe a patient's clinical data and experience.

- Surveillance and assessment of industry standard quality programs and metrics.

The Experience You- ll Need (Required):

- Nursing Degree with 1-3 years of direct patient care experience or Public Health related experience

- Experience with US medical claims coding systems - ICD10, CPT, Revenue Codes, Place of Service Codes, etc.

- Excellent attention to detail and dedication to team-based production of high quality deliverables

- Superb oral and written communication, organizational, and analytical skills

- Experience with MS Office product suite, especially with Excel, Word, PowerPoint

Finishing Touches (Preferred) :

- Experience with clinical quality measures (e.g., HEDIS, PQRS,CMS etc.)

- Experience with additional US Medical claims coding systems - SNOMED codes, LOINC codes, etc.

- Experience with US Rx claims coding system - RxNorm, GPI codes.

- Strong understanding in researching data issues; excellent analytical and QA skills; and ability to take large sets of data and find anomalies and troubleshoot data issues to ensure data integrity.

- Experience in analyzing, defining and documenting business processes and rules.

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