Clinical Content Advisor
To provide clinical expertise in collection and review of data content utilized in healthcare software applications that include medical necessity, quality reporting, evaluation and management service level determination and more.
Liaise as the clinical Subject Matter Expert (SME) for analyzing data collection. Assist with interpreting CMS national coverage determination (NCD) and local coverage determination (LCD) policies. Assist with identifying and interpreting commercial and other payer medical necessity data content for inclusion in software applications. Provide clear guidance on anatomy and physiology in relation to medical procedures and diagnoses. Provide clinical knowledge to coding specialists and developers. Assist in developing content for clinical edits such as identifying the appropriate administration methods and codes for each type of injectable (i.e. vaccines, immune globulins, etc.) Ensure accuracy and consistency in clinical edits. Review data content for accuracy.
Key Competencies Registered Nurse or Advanced Registered Nurse Practitioner license. (Prefer ARNP as a clinical nurse specialist.) Prefer five years of experience in a variety of clinical settings such as, but not limited to, Orthopedic, Critical Care, and OB/GYN Family Practice. Experience as a Practice Manager, Billing Manager or Coding manager in a medical office is a bonus. Credentialing in some area of coding, billing or medical office management eg. CPC, RHIA, CCS, CMM, PCS, CRS is a bonus. Knowledge of current coding and billing practices Proficient computer skills with MS Office Suite. Organizational and planning skills Communication skills Research and development skills Information gathering and monitoring skills Problem analysis and problem-solving skills Judgment and decision-making ability Initiative Confidentiality Team player Attention to detail and accuracy Adaptability
Standing, sitting, kneeling, stooping, lifting, bending, climbing, twisting upper body, walking, pushing, pulling, occasional lifting and carrying of large boxes up to 25 lbs., listening, talking, use of telephone, exposure to computer monitor screens and repetitive data entry.