Description |
As the world's largest healthcare services company with more than $90 billion in annual sales, McKesson Corporation (McKesson) is a Fortune 15 Corporation that provides pharmaceutical supply management and information technologies across the entire continuum of healthcare.
This opportunity is within the McKesson Health Solutions, Medical Management Group (MMG). The MMG offers a comprehensive suite of medical management products and services to help providers and payers better manage the cost and quality of care. Its CareEnhanceSM and InterQual solutions include: disease management, nurse triage, care management, utilization management, decision support criteria, and software that helps manage workflow, resources, and regulatory reporting processes.
Position Description
The Clinical Content Specialist develops, maintains and supports the KnowledgeBase content of McKesson¿s Claims Performance product line. The Claims Performance products are utilized by payor organizations to augment their claims management systems to optimize accurate processing of both professional and facility claims. This role is responsible for providing subject matter expertise involving facility billing/claims management to internal and external customers.
This position is responsible for articulating business/clinical requirements for facility claim processing to the software and content development teams. The role will be involved in developing acceptance criteria for release, will participate in acceptance testing of the releases to ensure the software and content are providing the appropriate results on the claim. This position would make recommendation for the standard set of facility rules and would design and test these rules. A content specialist is also responsible for quality assurance of the offered content and for responding to internal and external customer inquiries.
Key Responsibilities:
- Design, develop, and update professional/facility-based KnowledgeBase content and rules.
- Create detailed test scenarios used to test rule logic with software.
- Provide subject matter expertise to other clinical team members, software team members, and others, involving facility-based claims requirements.
- Design, develop and implement internal project release training. Facilitate meetings and perform presentations to small and medium sized groups.
- Serve as organizational subject matter expert for facility claims which may include training and support service assignments.
- Aggregate information gathered from literature reviews, guideline reviews, internet searches, coding system updates, consultant feedback, and client feedback and synthesize into relevant McKesson deliverables.
- Leads and facilitate workgroup or Joint Application Design (JAD) sessions with business, clinical group, and stakeholders.
- Serve as a KnowledgeBase resource for both internal and external customers.
- Participate in developing project plans, monitoring tasks and ensuring on-time delivery of clinical/content development projects.
- Perform Quality Assurance of KnowledgeBase content to include User Acceptance Testing using claims data.
- Serve as a liaison between clinical development and software product development, as needed.
- Create and maintain clinical/content documentation, as required.
- Establish and maintain productive relationship with expert consultants to McKesson for ongoing clinical content review and validation.
- Participate in or conduct field research that contributes to product advancement as needed.
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Requirements |
Minimum Requirements
Business Experience - Experience with inpatient/outpatient billing/claims; prior employment in the claims department of a major health plan is highly desired.
Minimum of 5 years healthcare experience to include: CPT and ICD-9-CM and ICD-9-PCS; managed care, data analysis, third party billing (facility billing mandatory and fraud and abuse beneficial), Medicare billing. ICD-10-CM/PCS knowledge also desired.
Additional Knowledge & Skills
- Business Systems Training/ Information Technology.
- Strong verbal and written communication skills.
- Results oriented; effective as both a team member and independent worker with attention to detail and ability to multi-task.
- Demonstrated proficiency with various software applications, including but not limited to: MS-Word; MS-Excel; MS-Visio; experience with MS-Access desirable.
- Demonstrated ability to use advanced analytical tools, (e.g. Excel graphics, pivot tables).
- Research capabilities, writing experience, project management skills and knowledge of clinical/facility coding schemes.
- Problem-solving skills; ability to step through logical pathways to determine results.
- Basic understanding of software development phases/life cycles a plus.
- Skills specific to individual product lines such as:
-- Ability to use Structured Query Language (SQL) a plus.
-- Understanding and ability to write conditional ¿if-then¿ statements (Boolean logic)
-- Thorough understanding of claims management billing systems is preferred.
Education
Advanced training in Health Care/Hospital Administration is essential: a Masters in Healthcare Administration (MHS) or comparable degree is desired; alternatively, a Registered Health Information Administrator (RHIA) or equivalent healthcare experience preferably in claims management will also receive strong consideration. Experience with inpatient/outpatient billing/claims is mandatory.
Physical Requirements
General Office Demands
Company Statement
McKesson offers a competitive compensation and benefits package.
McKesson is everywhere in healthcare. We offer a wealth of opportunity for individuals with a desire to make a difference in providing industry-leading, integrated healthcare services and solutions. Individuals with the passion to be a part of our entire continuum of patient-focused care. It's you and McKesson - empowering healthcare.
As an equal opportunity employer, McKesson Corporation unites the talents and contributions of all to advance the power of healthcare.
Agency Statement
No agencies please.
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