{"id":2805671,"url":"https://alion.io/job/coverself-clinical-content-specialist-payment-integrity","title":"Clinical Content Specialist (Payment Integrity)","company":{"id":4427716,"name":"Coverself","domain":"coverself.com","url":"https://alion.io/company/coverself","size_band":"51-200","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Keka","truth_index":null},"role":"Marketing","role_family":"Marketing","seniority":"junior","employment_type":"full_time","work_mode":"on_site","remote_scope":null,"remote_scope_basis":null,"remote_working_hours":null,"hiring_geo_confidence":"structured","locations":["Bengaluru, India"],"countries":["IN"],"hiring_countries":[],"hiring_countries_total":0,"salary":{"min":null,"max":700000,"currency":"INR","period":"year","gross":null,"usd_annual":7392},"salary_estimate":null,"experience_years_min":1,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[],"status":"live","first_seen_at":"2026-10-01T12:01:10Z","employer_posted_date":"2026-10-01","last_verified_at":"2026-10-20T17:50:44Z","board_verified":true,"closed_at":null,"days_open":19,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":19},"description":"About CoverSelf:\nCoverSelf 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.\nPosition Overview:\nThis role focuses on developing clinical content, payment integrity rules, and code edit solutions. The Clinical Content Specialist will translate clinical guidelines and payer policies into business logic, algorithms, and rule frameworks for automated claims validation.\nSpecialty Expertise:\nPayment Integrity\nClinical Coding & Policy Development\nClaims Prepayment Review\nData Mining & Content Development\nKey Responsibilities:\nDevelop and maintain payment integrity rules, edits, and policie\nDesign clinical logic & algorithms for claims validation\nTranslate CMS guidelines → business rules\nBuild code edit solutions to detect incorrect payments\nConduct research on medical policies and reimbursement methodologies\nEnhance and maintain policy libraries and rule frameworks\nSupport semi-automated claims review systems\nRequirements:\nStrong experience in Payment Integrity / Clinical Content / Policy building\nAbility to convert clinical guidelines into logical rules\nKnowledge of CMS policies, payer guidelines, and coding standards\nStrong analytical and problem-solving mindset\nSolid understanding of medical coding & billing methodologies and guidelines, including CPT, ICD, LCD/NCD, PTP, NCCI, edits, modifiers, Medicare Physician fee schedule, and coding conventions.\nProficiency in data collection, analysis, and deriving actionable insights from CMS medical policies, Medicaid Provider Manuals and other Medical publications.\nTranslate industry references into actionable business logic to support new rules and policy enhancements.\nStrong understanding of claim forms like UB-04/CMS 1450 and CMS 1500\nCollaborate effectively across teams while managing multiple priorities\nAbility to thrive in a fast-paced, dynamic environment with minimal supervision.\nDemonstrated mindset for continuous learning and improvement and apply insights to policy development, refinement and maintenance.\nStrong stakeholder management, interpersonal, and leadership skills.\nSolution-focused, motivated, entrepreneurial spirit with a strong sense of ownership.\nClear and effective communication.\nStrong attention to accuracy and detail in all deliverables\nQualifications\nEducation & Certification (one of the following required):\nMedical Degree (e.g., MBBS, BDS, BPT, BAMS etc)\nNursing: Bachelor/Master of Science in Nursing\nPharmacist Degree (B.Pharm, M.Pharm or PharmD)\nLife Science -Bachelor/Master\nCertification Requirements:\nMust hold any of the following certifications: CPC, CPMA, COC, CIC, CPC-P, CCS or any specialty certifications from AHIMA or AAPC.\nAdditional weightage will be given for AAPC specialty coding certifications.\nLean Six Sigma certification and practical application experience are preferred.\nExperience:\n1-3 years experience\nExperience in policy development, rule engines, or PI companies\nKey Skills:\nPayment Integrity domain knowledge\nClinical policy & content development\nCMS / Medicare / Medicaid guidelines\nCode edit logic (NCCI, LCD/NCD)\nStrong analytical & interpretation skills\nExcellent verbal & written communication skills.\nExcellent Interpretation and articulation skills\nStrong analytical, critical thinking, and problem-solving skills\nWillingness to learn new products and tools\nWork Details:\nLocation: Basavanagudi,Bangalore\nMode: Work from Office\nBenefits:\nBest-in-class compensation\nHealth insurance for Family\nPersonal Accident Insurance\nFriendly and Flexible Leave Policy\nCertification and Course Reimbursement\nMedical Coding CEUs and Membership Renewals\nHealth checkup\nAnd many more!\nOur Commitment to Diversity:\nAt CoverSelf, we are building a global workplace where every individual can discover their true potential, passion, and purpose - regardless of background, gender, race, sexual orientation, religion, or ethnicity. We believe a diverse workplace fosters innovation, creativity, and progress for our employees, communities, and business.","description_format":"text","description_chars":4300,"description_truncated":false,"requirements":{"experience_years_min":1,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"master","optional":false},"security_clearance":false,"languages":[]},"benefits":["Continuous learning","Health insurance"],"hiring_locations":[],"hiring_excludes":[],"relocation_offered":false,"industries":["Revenue Cycle & Medical Billing"],"lifecycle":[{"event":"open","at":"2026-10-18T05:24:15Z"}],"visa":[],"liveness":{"score":68,"band":"ok","label":"Likely open","p_open":1,"p_active":0.75,"p_room":0.9,"age_days":18,"expected_fill_days":28,"reasons":["conf:1","win:mid","comp:junior"],"computed_at":"2026-10-20T05:45:00Z"},"pay":{"stated_usd_annual":7392,"is_top_pay":false},"html_url":"https://alion.io/job/coverself-clinical-content-specialist-payment-integrity","json_url":"https://alion.io/job/coverself-clinical-content-specialist-payment-integrity.json","meta":{"generated_at":"2026-10-20T21:36:34Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":25165,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-21T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":4427716},"rest":"https://alion.io/mcp/rest/get_company?id=4427716"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fcoverself-clinical-content-specialist-payment-integrity"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fcoverself-clinical-content-specialist-payment-integrity"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fcoverself-clinical-content-specialist-payment-integrity"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/coverself-clinical-content-specialist-payment-integrity\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fcoverself-clinical-content-specialist-payment-integrity"}]}