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Clinical Content Specialist - Drugs & Biologicals - Payment Integrity

India, Bengaluru · Job Posted May 27, 2026
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Job Description

The Clinical Content Specialist – Pharmacy will be responsible for developing and validating high-quality content related to Drugs & Biologicals (D&B) within the US healthcare domain. The role focuses on ensuring accuracy, compliance, and clinical relevance of concepts that impact high-cost medical spend areas such as chemotherapy and specialty drugs. This position requires strong expertise in pharmacy, clinical interpretation, and healthcare coding to support payment integrity and reduce inaccurate reimbursements.

Job Responsibility

  • Requires a deep understanding of Pharmacy, Clinical aspects
  • Good understanding of Drugs and Biologicals and their classification
  • Awareness of Pharmacy regulatory bodies, like CDSCO, DCGI, DoP
  • Generic and Brand drugs awareness
  • Dosage determination, medical necessity, safety and compliance
  • Dosage and Administration
  • Medical Necessity
  • Frequency of Medication
  • Contraindication
  • Age/Gender
  • Adverse Drug Reaction
  • Off label usage
  • Good understanding of US Healthcare insurance Domain
  • Medical coding and reimbursement guidelines of US healthcare
  • NDC, HCPCS (J-codes), CPT, ICD, Modifiers, Revenue codes, etc
  • CMS, Medicaid guidelines, and payer policies
  • Understanding of Medical and Pharmacy Literatures
  • Familiarity of Drug Labels, FDA, Well-known Medical journals (Pub-Med, NCBI), CMS, Medicaid guidelines
  • Ability to read and Interpret complex of medical and pharmacy literatures
  • Extract Rule logic based on CS policies
  • Correlation of multiple literatures to arrive at conclusion

Requirements

  • Passionate about working in the pharmacy and clinical domain, with a focus on learning and growth
  • Should be passionate about pharmacy and the clinical side
  • Strong foundation in pharmacy and clinical concepts, including drugs and biologics
  • Demonstrated experience in research work, college thesis, or complex case study analysis
  • Strong research mindset with the ability to interpret clinical and medical literature
  • Excellent communication, articulation, and interpretation skills
  • Ability to translate complex clinical information into clear and structured insights
  • Sound clinical knowledge with attention to detail and accuracy
  • Pharm.D (Doctor of Pharmacy) – Preferred (Priority)
  • M.Pharm – Pharmacology / Clinical Pharmacy
  • CPC or COC certification – highly preferred
  • Freshers with a strong foundation in Pharmacy/Clinical concepts and a research mindset can be considered
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