McKesson is in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. McKesson Health Solutions delivers industry-leading clinical evidence and expert technology to help payers and providers collaborate for better healthcare outcomes at lower costs. Our solutions reduce unnecessary healthcare utilization while improving outcomes; operationalize complex volume- and value-based payment models; and optimize billing communication between providers, patients and payers. Our solutions are in more than four out of five payers in the country; more than 3,900 hospitals and facilities use our InterQual® evidence-based decision support criteria; and our RelayHealth® financial solutions are used to automate 1.9 billion financial transactions each year.
We understand the importance of a system that works together. Your expertise, drive and passion can help us carry out our mission to improve lives and advance healthcare.
Join our team of leaders to begin a rewarding career.
The Clinical Content Analyst develops, maintains and supports clinical content for McKesson’s Clinical Claims Management (CCM) Product Line in a fast paced environment with contractually driven quarterly deliverables. The CCM products are utilized by payer organizations to augment claims management systems in optimizing accurate processing of both professional and facility claims. This role is responsible for the end to end planning, development and maintenance of clinical content supporting the product business rules and content to the clinical management and team, and internal/external customers. The content developer is responsible for providing organizational training and written user documentation to clearly describe the clinical content developed. This role is also responsible to provide ad hoc support of clinical content to the organization during product implementations, and to work with the client facing teams or directly with customers in responding to client issues concerning product content as needed.
This role is responsible for the end to end planning, development and maintenance of linical content supporting the product business rules. The analyst will also design, develop, and update claims auditing content on a quarterly basis which includes but is not limited to:
- Provision of rule/content requirements
- Creation of functional (business) requirements documents if requested
- Participation in developing rule logic business requirements if requested
- Executing the creation and maintenance of clinical content
- Assist customers in troubleshooting rule logic and content outcome issues (determine if outcome is defect and determine its criticality)
- Perform Quality Assurance of clinical content to include: peer review of proposed content, validation measures to ensure content integrity, documentation of content assumptions and methodology as indicated and User Acceptance Testing (UAT) as needed
- Acts as Subject Matter Expert (SME) on medical billing and coding topics as well as content developed
- Research data for identification of clinical content (CPT, ICD-10-CM, ICD-10-PCS, & other code sets) opportunities or required maintenance gathered from coding and billing guidelines, clinical literature, healthcare industry guidelines, including but not limited to National coding standards, CMS transmittals, CMS payment policies, regulatory policies, coding system updates, consultants and client feedback and relate it back to product content recommendations, development, maintenance and support for all McKesson code auditing solutions.
- Work closely with the Analytics team to complete data analysis using benchmark data (or other available sources) to either identify new opportunity or validate/confirm development.
- Create and Maintain Clinical User Documentation (internal and external product users) and content reports on quarterly basis.
- Prepare and deliver rule and content training sessions on a quarterly basis to both internal and external customers, as needed
- Serve as a clinical resource for stakeholders, internal and external customers to support product content.
4+ years experience in clinical/healthcare field, computer applications, or business analysis.Critical Skills
- 1+ years of relevant Healthcare experience with inpatient/outpatient billing/claims systems required.
- In depth knowledge of professional and/or facility medical billing required
- Ability to successfully manage multiple priorities with deliverables completed on time and with high quality.
- Research capabilities, writing experience, and current working knowledge of government and commercial payer guidelines required.
- Demonstrated proficiency with various software applications, including but not limited to: MS Word; MS Excel; MS Access; Visio; Outlook.
- Outstanding problem solving skills; ability to step through logical pathways to confirm expected results.
- Strong analytical skills
- Excellent communication, interpersonal, presentation/computer skills
- Results oriented; effective as both a team member and independent worker with strong attention to detail
- Aptitude for working with McKesson developed applications in support of work objectives.
Additional Knowledge & Skills
- Third party claims processing, Medicare billing, and/or physician group practice experience preferred.
- Healthcare Systems Information technology background and/or experience with strongly preferred.
- Experience as a medical claims or medical chart auditor is a plus.
- Basic understanding of software development phases/life cycles a plus
- Ability to use Access a plus
- Must obtain national coding certification within 6 months of employment hire date
4-year degree in nursing or healthcare-related field or equivalent experiencePhysical Requirements
General Office DemandsBenefits & Company Statement
McKesson believes superior performance – individual and team – that helps us drive innovations and solutions to promote better health should be recognized and rewarded. We provide a competitive compensation program to attract, retain and motivate a high-performance workforce, and it’s flexible enough to meet the different needs of our diverse employee population.
We are in the business of better health and we touch the lives of patients in virtually every aspect of healthcare. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.
But we can’t do it without you. Every single McKesson employee contributes to our mission—whatever your title, whatever your role, you act as a catalyst in a chain of events that helps millions of people all over the globe. Talented, compassionate people are the future of our company—and of healthcare. At McKesson, you’ll collaborate on the products and solutions that help us carry out our mission to improve lives and advance healthcare. Working here is your opportunity to shape an industry that’s vital to us all.
McKesson is an equal opportunity and affirmative action employer – minorities/females/veterans/persons with disabilities.
Qualified applicants will not be disqualified from consideration for employment based upon criminal history.Agency Statement
No agencies please.