Location: Hyderabad
Experience: 3+ Years
Qualification: RN/USRN or MBBS
Job Summary
Eclat Health Solutions is hiring experienced clinical reviewers to support AI/LLM training for prospective risk adjustment workflows. The role involves reviewing longitudinal medical records, identifying clinically supported suspected conditions, validating AI-generated outputs, and providing structured clinical feedback to improve model accuracy.
Key Responsibilities.
- Review medical records, physician notes, labs, medications, and diagnostic findings.
- Identify clinically supported suspected conditions using CDI and TAMPER principles.
- Validate and refine AI/LLM-generated suspect conditions.
- Differentiate active conditions from historical, resolved, or unsupported findings.
- Document clinical evidence and rationale for identified suspects.
- Collaborate with Clinical, Coding, Quality, and AI teams to improve model performance.
Required Skills & Experience
- RN/USRN or MBBS qualification.
- Minimum 3 years of experience in CDI, medical record review, utilization review, quality review, or related clinical review functions.
- Strong understanding of chronic disease processes and clinical documentation.
- Working knowledge of ICD-10-CM terminology and documentation requirements.
- Experience reviewing outpatient physician records and longitudinal medical records.
- Strong analytical, clinical reasoning, and communication skills.
Preferred
- Experience in Risk Adjustment, HCC Coding, Prospective CDI, or Suspecting.
- Knowledge of CMS-HCC methodologies.
- CRC, CCDS, or CDIP certification.
- Experience with AI-assisted clinical review or validation projects.
Apply if you have solid clinical review expertise and are interested in contributing to next-generation AI-driven healthcare solutions.