Core responsibilities include:
- Evaluate and recommend improvements to the current clinical tools include but not limited to diagnosis related groupers, disease episode groupers, patient risk scores, disease staging tools
- Evaluate and recommend improvements for relative indices such as risks scores, disease burden index and case mix that support our clinical tools
- Understand the final usage of the tools and recommend relevant insights for clinical tool evolution
- Provide clinical support in the analysis of claims data to derive actionable clinical insights
- Participate in the application of the tools in various business processes and engage with Customers to discuss the effective usage of clinical tools
- Create and assist in the development of Clinical Pathways for a range of products such as Condition Management, Hospital Optimization, Palliative Care, etc.
- Review the clinical appropriateness of product designers
- Supporting clinical coding teams in the creation, update and maintenance of clinical classifications
- Research and develop/implement various clinical terminologies and ontologies (such as SNOMED-CT, LOINC, WHO ICD-10, ICD10CM, ICD11, CPT, ATC etc.) for integration and enhancement for our clinical tooling
What skills do you need?
Behavioural skills
- Exceptional communication skills across a wide range of stakeholders
- Ability to work cohesively in a team environment while balancing multiple priorities
- High level of attention to detail, resilience, enthusiasm, energy and drive
- Positive, can-do attitude focused on continuous improvement
- Ability to take feedback and constructive criticism to drive improved delivery
- Rigorous ability to problem-solve and optimise environment
- Excellent co-ordination skills
Technical understanding
A working understanding of the data used in healthcare is optimal as data forms the basis of our products, as such the following core understandings are required:
- Understanding of healthcare specific data/ health Insurance claims is a must.
- Reasonable competence in use of Microsoft Office suite of tools especially Excel, Access and PowerPoint
- Knowledge of patient health management, provider profiling, healthcare reporting, and other key healthcare technologies, etc.
- Knowledge of clinical tools and coding including coders, groupers, cross walks and classifications
- Jira and Confluence Knowledge
- Agile ways of working
- Understanding of Tech Products Lifecycle
- Strong DRG and Clinical Coding foundation
- Databricks knowledge
- Experience in clinical reviews for output sanity checks
- Experience in Closed File Review for missed recovery/ prevent FWA opportunities.
- Experience in working with Health Tech Team (Project Manager, Data Scientists, Data Analysts)
The below understandings are advantageous however not compulsory:
- SQL, python, and advanced excel is
- Understanding of advanced statistics, risk adjustment and health outcome indices and metrics
- Knowledge of usage of data science in the healthcare space
- Experience in Microsoft Azure (Databricks, Synapse, Data Factory, etc.)
Qualifications
The following requirements are essential:
- Graduate Health Care qualification required, preferably a Medical degree with a minimum of 5 years of post-qualification experience.
- Private health care experience would be an advantage.
- Qualifications or training in Health informatics, clinical coding or Health Administration would be very helpful
