Clinical Content Specialist (Payment Integrity - Drugs & Biological)

This role is not for 2070 Health.

CoverSelf empowers US healthcare payers with a truly next-generation, cloud-native, holistic, and customizable platform designed to prevent and adapt to the ever-evolving inaccuracies in healthcare claims and payments. By reducing complexity and administrative costs, we offer a unified, healthcare-dedicated platform backed by top VCs like BeeNext, 3One4 Capital, and Z21 Ventures.

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.

• →Requires a deep understanding of Pharmacy, Clinical aspects
  

• Good understanding of Drugs and Biologicals and their classification
• Awareness of Pharmacy regulatory bodies, like CDSCO,DCGI,DoP
• Generic and Brand drugs awareness
• Dosage determination, medical necessity, safety and compliance.
  

• 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 CoverSelf Policies and Sub-Policies
• Research and ideation of concepts based on CoverSelf Policies and Medical and pharmacy literatures and drug labels
  
• 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

• 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
  

Pharm.D (Doctor of Pharmacy) – Preferred (Priority)

M.Pharm – Pharmacology / Clinical Pharmacy

CPC or COC certification – highly preferred

Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered.

• Location: Jayanagar, Bangalore
• Mode: Work from Office