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Clinical Pharmacy Analyst (8520)

Keywords / Skills : Clinical Analyst

1 - 5 years
Posted: 2019-10-03

Job Description
Job Description 
The Clinical Pharmacy 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.

Clinical content includes but is not limited to CPT codes, ICD-10-CM diagnosis codes, HCPCS codes, POS codes, and other code sets and the translation of written clinical information into auditable clinical content.

Content development is defined as the identification of a clinical term or medical condition and translating it into a procedure code, diagnosis code or any other code set element as appropriate.

In addition, the Analyst/Developer is responsible for clearly and concisely articulating any clinical content changes that are recommended by the Analyst/Developer, as needed. This discussion would occur during weekly team meetings or other clinical content meetings where discussion of clinical content would be required.

Requirements 
  • Research, develop and maintain Specialty Drugs Medical policies based on information from FDA, National Comprehensive Cancer Network (NCCN), Clinical Pharmacology (CP) or other published study i.e. Medical literatures;
  • Responsible for the review clinical content data sources to create update, add or delete clinical content (clinical content meaning CPT, HCPCS, ICD-10-CM, ICD-10-PCS, & all other code sets)
  • Responsibilities also include:
  • Maintaining the Clinical Manuals of Specialty Drugs through research using drug literature and Compendia's.
  • Ability to follow Specialty Pharmacy project development philosophy and codes drugs policy accordingly.
  • Work closely with Medical Director in developing Medical policies for Specialty Pharmaceutical agents based on recommended sources.
  • Assigning and mapping all valid ICD-10 CM codes billable for each On-Label as well as Off-Label indication for a given pharmaceutical agent.
  • Updating other claim's billing criteria i.e. Age or Maximum units allowed based on drug administration for each indication for a given pharmaceutical agent.
  • Performing analysis of specialty drugs and drug content information included in Local Coverage Determinations (as needed)
  • The Clinical Content Analyst/Developer is responsible for performing all required clinical content updates in all content database tools as necessary.
  • The Analyst/Developer is responsible for clearly and concisely articulating any clinical content changes that are recommended by the Analyst/Developer, as needed. These discussions would occur during weekly team meetings or other clinical content meetings where discussion of clinical content would be required.
Other Skills/Qualifications Needed:


One year or more relevant healthcare experience as a medical coder, medical biller, medical claims processor, claims reviewer, bill reviewer or medical chart auditor/abstractor is strongly preferred. 
 

Specialized Knowledge/Skills:
  • Knowledge in Pharmaceutical data informatics.
  • Sound knowledge in US healthcare and Clinical Pharmacy.
  • Ability to perform Pharmacy benefit analysis, research, quality reviewing and implementing the same.
  • Strong working knowledge of HCPCS codes & guidelines, current ICD-10-CM codes and guidelines as well as current medical coding and billing guideline expertise strongly preferred
  • HIPAA compliance.
  • Efficient in MS software including Excel, Word and PowerPoint.
  • 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.

Key Skill(s)

About Company

MicroSourcing Philippines Inc, is one of the leading outsourcing solutions providers in the Philippines. We specialize in setting up offshore operations for foreign clients who operate in a wide variety of industries all over the world. Our offices are located in the Eastwood City Cyberpark, Mall of Asia Complex, Bonifacio Global City, Ortigas and Cebu IT Park and form the perfect professional environment from which we can run our various projects. MicroSourcing is a fast moving and flexible company with a great international management team.
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