hiring clinical professionals for a leading US Healthcare entity. We are looking for experienced healthcare candidates (Doctors & Registered Nurses) to join our growing clinical teams in Clinical Denials & Appeals and Clinical Documentation Improvement (CDI).

Role 1: Clinical Denials & Appeals (Specialist / Sr. Specialist / QA / Trainer)

- Core Focus: Reviewing US medical necessity denials, assessing clinical records, and drafting formal appeal letters to overturn insurance claim rejections.

Key Responsibilities:

- Analyze complex US healthcare payer denials related to medical necessity, level of care, and authorization.
- Review inpatient/outpatient clinical records, physician notes, and lab reports against US clinical guidelines (e.g., MCG, InterQual).
- Draft persuasive, high-quality clinical appeal letters supported by medical evidence and payer policies to secure reimbursement.
- Track appeal outcomes and collaborate with internal teams to identify root causes of claim rejections.

Qualifications & Eligibility:

- Education: MBBS, MD, BDS, BHMS, BPT, B.Sc Nursing, or M.Sc Nursing.
- Experience: 2+ years of hands-on experience in US Healthcare Denials & Appeals, Utilization Review,



or Utilization Management.
- Preferred Certifications: CPC, CCS, or COC (Optional).

Role 2: Clinical Documentation Improvement - CDI (Specialist / Sr. Specialist / QA / Trainer)

- Core Focus: Reviewing inpatient hospital records to ensure clinical documentation accurately reflects patient severity of illness and supports proper IPDRG coding.

Key Responsibilities:

- Perform concurrent and retrospective chart reviews of inpatient medical records for accuracy and documentation integrity.
- Identify documentation gaps, clinical discrepancies, and missing diagnoses.
- Collaborate directly with physicians and healthcare providers by writing explicit, compliant clinical queries.
- Support accurate Inpatient Diagnosis-Related Group (IPDRG) assignment and severity/risk factor capture.

Qualifications & Eligibility:

- Education: MBBS, MD, B.Sc Nursing, or M.Sc Nursing ONLY. (
- Clinical Experience: Minimum 2+ years of hands-on bedside clinical experience (ICU, NICU, Surgical, or General Ward).
- Domain Experience: Mandatory experience in Inpatient CDI OR IPDRG Coding.

📌 Healthcare Experts - Clinical Denials & Appeals / CDI (Hyderabad)
🏢 Saaki Argus And Averil Consulting
📍 Hyderabad