Position Summary (Purpose of job):
The Clinical Content Analyst/Developer researches, analyzes and creates clinical content for the business 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 content development of new and revised clinical content to be offered in existing or new business rules, to expand the CCM suite of offerings.
Clinical content includes but is not limited to CPT codes, ICD-10-CM diagnosis codes, HCPCS codes, POS codes, DRG’s, APC’s 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, surgical procedure 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.
1. Research, analyze and 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) opportunities. The Analyst/Developer is responsible for the creation and development of the clinical content to support new and existing CXT business rules.
Clinical Content sources includes but is not limited to:
· Medicare Claims Processing manual
· CMS transmittals
· AMA publications
· CPT changes and new code updates
· HCPCS code updates,
· NCCI policy manuals,
· Medicaid Policy Edit & Design manuals
· ICD-10-CM diagnosis code updates
· ICD-10-PCS procedure code updates
· National Coverage Determinations (NCDs)
· Local Coverage Determinations (LCDs)
· State Medicaid manuals, bulletins, banners & publications
· Other 3rd party clinical content sources
The Clinical Content Analyst/Developer is responsible for reviewing all clinical content sourcing documentation for added content, revised content or deleted clinical content.
The Clinical Content Analyst/Developer is responsible for performing all appropriate clinical content research.
The Clinical Content Analyst/Developer is responsible for performing all required clinical content updates in all content database tools as necessary.
The Clinical Content Analyst/Developer is responsible for understanding the basic CXT rule function to development and maintain clinical content.
2. 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.
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