hiring clinical specialists 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