3603-Senior Associate-Clinical Informatics

We are seeking a highly motivated and clinically experienced Senior Clinical Coding Specialist to join our team of Clinical Informaticists (Analytics), 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, and a passion for leveraging data to drive better health outcomes and cost efficiencies. This role bridges clinical knowledge with analytics, supporting strategic decision-making and operational excellence across value-based care programs. RequirementsClinical Strategy & SupportProvide 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.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. 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. ValueSet Evaluation & Maintenanceo   Validate ValueSets for accuracy and alignment with payer criteriao   Identify missing or incorrect codes that impact clinical rules logicAuthoring & Version Control Create and manage ValueSets Maintain audit logs and track updates to keep rules currentClinical Coding & Terminology Expertiseo   Serve as the coding expert for SNOMED, LOINC, CPT, ICD-10-CM, RxNormo   Translate clinical guidelines into accurate code setso  Interact with Analytics and Customer Success teams to help develop and validate NLP tools for clinical coding and documentationCollaboration with Product & Engineeringo   Prioritize rule development with product and clinical teamso   Ensure proper ValueSet binding and participate in QA reviewsData Quality & Model Supporto   Review EHR data to confirm ValueSet effectivenesso   Identify and correct data mismatches or terminology gapsScalability & Coverage Expansiono   Build reusable ValueSet templates for scalable rule creationo   Support expansion across CPTs, payers, and clinical domainsData 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.o   Assist with the design and content of Dashboards that are built within PowerBI 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 contractsQualifications and ExperienceClinical Experience o   5+ years of clinical experience in a healthcare setting. o   Minimum two years of medical coding experience o   Any US healthcare experience would be an additional asset o   Strong understanding of the U.S. healthcare system, including value-based care models Understanding medical terminologies (RxNorm, LOINC, SNOMED, CPT, ICD-10-CM, CPT, HCPCS, etc.)Understanding of body systems/anatomy, physiology and concepts of disease processes.Hands-on experience with value set authoring tools (e.g., FHIR terminology services) is preferable.Knowledge of HL7 FHIR terminology resources and value set binding methodologiesDeep 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 sessionsAbility to work in US central time zone while in India typically 12 noon to 20 30 IST Preferred:     Experience working in the US healthcare environment plan, strong familiarity with ACO's, healthcare systems, or population health management setting.     Knowledge of HCC coding, risk adjustment, and quality metrics (e.g., HEDIS, STAR ratings).      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 CompetenciesAnalytical 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 BenefitsWe offer competitive benefits to set you up for success in and outside of work.Here's What We OfferGenerous 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 Additionally, please exercise caution and verify the authenticity of any requests before disclosing personal and confidential information, including bank account details.About InnovaccerInnovaccer 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 human touch in healthcare. 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