About the role
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
- 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 clear 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.
QualificationsEducation & 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
- Must hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.
- 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 new products and tools
- Location: Jayanagar, Bangalore
- Mode: Work from Office
- 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!