Clinical Content Specialist – Drugs & Biologicals – Payment Integrity.
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Job Location:
Monthly Salary:
Posted on:
3 hours ago
Vacancies:
1 Vacancy
Job Summary
JOB DISCRIPTION:
Position Overview:
The Clinical Content Specialist Pharmacy will be responsible for developing and validating high-quality content related to Drugs & Biologicals (D&B) within the US healthcare domain. The role focuses on ensuring accuracy compliance and clinical relevance of concepts that impact high-cost medical spend areas such as chemotherapy and specialty drugs. This position requires strong expertise in pharmacy clinical interpretation and healthcare coding to support payment integrity and reduce inaccurate reimbursements.
Key Responsibilities:
- Requires a deep understanding of Pharmacy Clinical aspects.
Pharmacy Aspects:
- Good understanding of Drugs and Biologicals and their classification.
- Awareness of Pharmacy regulatory bodies like CDSCODCGIDoP.
- Generic and Brand drugs awareness.
- Dosage determination medical necessity safety and compliance.
Clinical Aspects:
- Dosage and Administration
- Medical Necessity
- Frequency of Medication
- Contraindication
- Age/Gender
- Adverse Drug Reaction
- Off label usage
- Good understanding of US Healthcare insurance Domain:
- Medical coding and reimbursement guidelines of US healthcare.
- NDC HCPCS (J-codes) CPT ICD Modifiers Revenue codes etc...
- CMS Medicaid guidelines and payer policies.
- Understanding of Medical and Pharmacy Literatures:
- Familiarity of Drug Labels FDA Well-known Medical journals (Pub-Med NCBI) CMS Medicaid guidelines.
- Ability to read and Interpret complex of medical and pharmacy literatures.
- Extract Rule logic based on CS policies.
- Correlation of multiple literatures to arrive at conclusion.
Requirements:
- Passionate about working in the pharmacy and clinical domain with a focus on learning and growth.
- Should be passionate about pharmacy and the clinical side.
- Strong foundation in pharmacy and clinical concepts including drugs and biologics.
- 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.
Educational Qualifications:
Pharm.D (Doctor of Pharmacy) Preferred (Priority)
Pharmacology / Clinical Pharmacy.
Certification Requirements:
CPC or COC certification highly preferred.
Experience:
Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.
Work Details:
- Location: Jayanagar Bangalore
- Mode: Work from Office
