Senior Associate-clinical Informatics

We are seeking a highly motivated and clinically experienced Clinical Informaticist to join our team of Clinical Informaticists Analytics in the role of Senior Associate- Clinical Informaticist contributing to our efforts in transforming healthcare delivery through Value-Based Care VBC initiatives The ideal candidate will have a deep understanding of the U S healthcare system a strong clinical background understanding of health information exchange workflows and processes and a passion for leveraging data to drive better health outcomes and cost efficiencies This role bridges clinical knowledge with informatics and analytics supporting strategic decision-making and operational excellence across value-based care programs Requirements Clinical Strategy Support Provide clinical insights and subject matter expertise to support classifying clinical guidelines for example CMS and associate them with relevant clinical codes Provide clinical insights and subject matter expertise to support clients with the design implementation and optimization of value-based care models Models include HCC coding disease level coding utilization patterns chronic care management strategies risk modelling Collaborate with internal stakeholders risk analysis care management quality improvement IT analytics to develop care models and dashboards that inform on the organizations performance that are designed to improve patient outcomes and reduce total cost of care Provide insights from the Client data clinical payer claims and ADT with Strategies that could be adopted and operationalized to influence patient outcomes and revenue for the organization with patients under the Fee-For-Service model ValueSet Evaluation Maintenance Authoring Version Control - Create and manage ValueSets - Validate and maintain ValueSets for accuracy and alignment with payer criteria - Identify missing or incorrect codes that impact clinical rules logic - Maintain audit logs and track updates to keep clinical rules current Clinical Coding Terminology Expertise o Serve as the coding expert for SNOMED LOINC CPT ICD-10-CM RxNorm o Translate clinical guidelines into accurate code sets Collaboration with Product Engineering o Prioritize rule development with product and clinical teams o Ensure proper ValueSet binding and participate in QA reviews Data Quality Model Support o Review EHR data to confirm ValueSet effectiveness o Identify and correct data mismatches or terminology gaps Scalability Coverage Expansion o Build reusable ValueSet templates for scalable rule creation o Support expansion across CPTs payers and clinical domains Assist with the design and content of Dashboards are built within PowerBI Data Analysis Interpretation o Analyse clinical and payer claims data to identify trends care gaps and performance opportunities in VBC and non-VBC arrangements e g ACOs MSSP MA Medicaid Managed Care Fee-For-Service o Use tools like SQL Excel or Power BI to extract and interpret data to inform clinical interventions and operational planning Performance Monitoring Reporting o Develop and review reports design dashboards on clinical quality Measurable o Patient Outcomes including utilization and cost metrics tied to Patient Care for any patient population o Help evaluate the effectiveness of care interventions and population health programs using data-driven insights Stakeholder Communication o Present findings and recommendations to both clinical and non-clinical stakeholders translating data into actionable strategies o Act as a liaison between clinical teams and data IT teams to ensure data needs are well-communicated and accurately implemented as well as managing SME relationships with Customer Success Teams client facing leaders of client Management finding the balance and enabling the team with the information and becoming the trusted advisor with the clinical information Regulatory Contractual Awareness o Maintain up-to-date knowledge of CMS NCQA HEDIS and other regulatory frameworks relevant to VBC and other CMMI programs o Understand payer requirements and assist with compliance and reporting for risk-bearing contracts Qualifications and Experience Minimum 7 years of hands-on experience in multispecialty medical coding and data analytics o Any US healthcare experience would be an additional asset o Strong understanding of the U S healthcare system including value-based care models o A degree in Master of Health Clinical Informatics is preferred Interacting with Analytics and Customer Success teams to help develop and validate NLP tools for clinical coding and documentation Understanding medical terminologies RxNorm LOINC SNOMED CPT ICD-10-CM CPT HCPCS etc Understanding clinical information exchanges and mechanisms Review abstract and validate CMS and payer-specific clinical and claims documentation guidelines Knowledge of HL7 FHIR terminology resources and value set binding methodologies Deep understanding of clinical workflows EHRs and clinical documentation guidelines for medical coding Experience using clinical data and analytics to help develop new solutions to existing healthcare problems and population health strategies Intermediate understanding of SQL and experience working with clinical or claims datasets Familiarity with data visualization and reporting tools e g Excel Power BI Tableau Ability to translate clinical and operational challenges into data requirements and actionable insights Proven ability to review and provide feedback on AI-generated coding outputs Stay updated on industry changes and attend relevant training sessions Ability to work in US central time zone while in India typically 12 noon to 20 30 IST Preferred Experience in Family Medicine Internal Medicine Behavioral Health and Pathology Familiarity with AI-driven coding platforms and automation tools Familiarity with ACO s healthcare systems or population health management setting Experience working with Python R or SAS for data manipulation and statistical analysis Background in quality improvement utilization management or care coordination is preferred Core Competencies Analytical thinking and clinical problem-solving Strong communication and presentation skills Cross-functional collaboration and team orientation Attention to detail with a systems-thinking mindset Passion for improving healthcare delivery and outcomes Benefits We offer competitive benefits to set you up for success in and outside of work Here s What We Offer Generous Leaves Enjoy generous leave benefits of up to 40 days Parental Leave Leverage one of industry s best parental leave policies to spend time with your new addition Sabbatical Want to focus on skill development pursue an academic career or just take a break We ve got you covered Health Insurance We offer comprehensive health insurance to support you and your family covering medical expenses related to illness disease or injury Extending support to the family members who matter most Care Program Whether it s a celebration or a time of need we ve got you covered with care vouchers to mark major life events Through our Care Vouchers program employees receive thoughtful gestures for significant personal milestones and moments of need Financial Assistance Life happens and when it does we re here to help Our financial assistance policy offers support through salary advances and personal loans for genuine personal needs ensuring help is there when you need it most Innovaccer is an equal-opportunity employer We celebrate diversity and we are committed to fostering an inclusive and diverse workplace where all employees regardless of race color religion gender gender identity or expression sexual orientation national origin genetics disability age marital status or veteran status feel valued and empowered Disclaimer Innovaccer does not charge fees or require payment from individuals or agencies for securing employment with us We do not guarantee job spots or engage in any financial transactions related to employment If you encounter any posts or requests asking for payment or personal information we strongly advise you to report them immediately to our HR department at px innovaccer com Additionally please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information including bank account details About Innovaccer Innovaccer activates the flow of healthcare data empowering providers payers and government organizations to deliver intelligent and connected experiences that advance health outcomes The Healthcare Intelligence Cloud equips every stakeholder in the patient journey to turn fragmented data into proactive coordinated actions that elevate the quality of care and drive operational performance Leading healthcare organizations like CommonSpirit Health Atlantic Health and Banner Health trust Innovaccer to integrate a system of intelligence into their existing infrastructure extending the 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