# Clinical Content Specialist (Payment Integrity - Drugs & Biological)

**Company:** [2070Health](http://jobs.workable.com/companies/uKzL69ePFf1Gu7nVvi5kdz.md)
**Location:** Bengaluru, India
**Workplace:** on site
**Employment type:** Full-time
**Department:** 2070 Health

[Apply for this job](http://jobs.workable.com/view/90ff47ce-f29e-4e1f-8aa7-8ac183b4fdd0)

## Description

This role is not for 2070 Health.

**About CoverSelf:**

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.

**Position Overview:**

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.

**Key Responsibilities:**

-   Requires a deep understanding of Pharmacy, Clinical aspects  
    

**Pharmacy 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.  
    

**Clinical Aspects**

-   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

**Requirements:**

-   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  
    

**Educational Qualifications:**

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

M.Pharm – Pharmacology / Clinical Pharmacy

**Certification Requirements:**

CPC or COC certification – highly preferred  

**Experience:**

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

**Work Details:**

-   **Location:** Jayanagar, Bangalore
-   **Mode:** Work from Office  
    

**Benefits:**

-   Best-in-class compensation
-   Health insurance for Family
-   Personal Accident Insurance
-   Friendly and Flexible Leave Policy
-   Certification and Course Reimbursement
-   Medical Coding CEUs and Membership Renewals
-   Health checkup
-   And many more!