Senior Clinical Tool Specialist

You will assist and lead in the research, creation and development of Clinical Tools and Classification Systems such as groupers, classifiers, stagers, and patient segmentation. Work in a collaborative manner with support from data analyst to data scientist to ensure our clinical tools are world class and fit for the purposes of clinical risk management (ranging from cost containment to quality and clinical pathways).

Core Responsibilities Include

How you would make a difference

• 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

Behavioural Skills

What you need to be successful

• 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 optimize environment.
• Excellent co-ordination skills

Technical understanding

Required

A working understanding of the clinical data used in healthcare is optimal as data forms the basis of our products, as such the following core understandings are required

• Knowledge 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
• 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:

• Physician/MBBS degree as a clinical qualification required. 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.