Clinical Authorization Specialist

2 days ago

Hyderabad, Telangana, India PractoPulse Healthcare Services Private Limited Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Role & responsibilities

  • Prioritization and Prior Approval: Responsible for evaluating the patient's condition, determining the medical necessity, and submitting the necessary documentation to the insurance company for approval ensuring that the proposed treatment or service is covered by the insurance policy before it is performed.
  • Medical Necessity Determination: Responsible to provide additional documentation or explanation to support the medical necessity of specific treatments or procedures justifying the necessity of certain medical interventions to ensure proper reimbursement.
  • Diagnosis and Treatment Coding: Responsible to assign appropriate diagnosis codes (ICD-10) and procedure codes (such as Current Procedural Terminology or CPT codes) to accurately represent the patient's condition and the medical services rendered which are necessary for billing and reimbursement purposes.
  • Insurance Communication: Liaise with insurance companies to obtain preauthorization, clarify requirements, resolve discrepancies, and ensure timely approval of medical services.
  • Clinical Documentation Review: Review clinical notes, test results, and physician documentation to ensure completeness and compliance with insurance and regulatory standards.
  • Compliance and Quality Assurance: Ensure all prior authorization requests and medical documentation comply with HIPAA regulations, payer guidelines, and internal quality standards.
  • Denial Management: Analyze and respond to denied authorization requests by providing additional medical justification or appealing based on medical necessity.
  • Record Maintenance: Maintain accurate records of authorization requests, approvals, denials, and correspondence for audit and reference purposes.

Preferred candidate profile

  1. MBBS from India, MBBS from foreign countries like China, Russia, Ukraine etc., BHMS, BAMS,

BDS, MDS

  1. Night Shift only

  2. Work from Office only

  3. MS Office (Word, Excel, Power Point) usage

  • Oncology Authorizations Specialist

    1 hour ago

    Hyderabad, Telangana, India NexCen Global Inc Full time ₹ 5,00,000 - ₹ 15,00,000 per year

    Role DescriptionThis is a full-time, on-site role for an Oncology Authorizations Specialist, based in Hyderabad. The Specialist will be responsible for securing prior authorizations for oncology services, liaising between healthcare providers and insurance companies, and ensuring compliance with organizational and payer guidelines. Tasks also include patient...

  • Clinical Specialist

    4 days ago

    Hyderabad, Telangana, India IQVIA Full time ₹ 15,00,000 - ₹ 30,00,000 per year

    Clinical Specialist / Stroke Rater – Punjabi SpeakingLocation: RemoteHours: Estimated 2–12 hours per month, flexibleRole OverviewThe Clinical Specialist supports stroke clinical trials by administering standardized assessments and ensuring data quality and consistency. This includes rating patients using validated stroke scales and reviewing assessments...

  • Clinical Documentation Specialist

    1 week ago

    Hyderabad, Telangana, India Randstad Full time ₹ 9,00,000 - ₹ 12,00,000 per year

    This will be a rotational shift job.11 AM to 8 PM, 2 PM to 11 PM, 6.30 PM to 3.30 AM.If interested, pls share CV on As a CDI Specialist, you will review clinical documentation in electronic health records to ensure accuracy, completeness, and compliance with coding standards. You will issue compliant queries to physicians and collaborate with internal teams...

  • Clinical Policy Specialist

    2 weeks ago

    Hyderabad, Telangana, India Cohere Health Full time ₹ 6,00,000 - ₹ 12,00,000 per year

    Opportunity Overview:Join our Clinical Content team and play a key role in shaping evidence-based medical policy configurations that drive smarter, more efficient healthcare decisions. This opportunity offers a unique blend of clinical insight, technology, and collaboration across product, engineering, and medical teams. You'll help ensure our platform...

  • Clinical Policy Specialist

    2 weeks ago

    Hyderabad, Telangana, India Cohere Health Full time ₹ 12,00,000 - ₹ 24,00,000 per year

    Opportunity Overview:Join our Clinical Content team and play a key role in shaping evidence-based medical policy configurations that drive smarter, more efficient healthcare decisions. This opportunity offers a unique blend of clinical insight, technology, and collaboration across product, engineering, and medical teams. You'll help ensure our platform...

  • Clinical Documentation Specialist

    1 week ago

    Hyderabad, Telangana, India PractoPulse Healthcare Services Private Limited Full time ₹ 2,00,000 - ₹ 6,00,000 per year

    Job DescriptionMinimum 2 years of experience in medical transcription and scribing is required.We are looking for a Clinical Documentation Specialist. The ideal candidate will be responsible for creating accurate medical transcription documents from audio recordings, interpreting medical jargon, ensuring documentation quality, and supporting healthcare...

  • Clinical Trial Registration Specialist

    2 weeks ago

    Hyderabad, Telangana, India Bristol Myers Squibb Full time ₹ 12,00,000 - ₹ 24,00,000 per year

    Working with UsChallenging. Meaningful. Life-changing. Those aren't words that are usually associated with a job. But working at Bristol Myers Squibb is anything but usual. Here, uniquely interesting work happens every day, in every department. From optimizing a production line to the latest breakthroughs in cell therapy, this is work that transforms the...

  • Clinical Trial Registration Specialist

    2 weeks ago

    Hyderabad, Telangana, India Bristol Myers Squibb Full time ₹ 8,00,000 - ₹ 12,00,000 per year

    Working with UsChallenging. Meaningful. Life-changing. Those aren't words that are usually associated with a job. But working at Bristol Myers Squibb is anything but usual. Here, uniquely interesting work happens every day, in every department. From optimizing a production line to the latest breakthroughs in cell therapy, this is work that transforms the...

  • Clinical Liaison Specialist, GP Hyderabad

    4 days ago

    Hyderabad, Telangana, India Align Technology Full time ₹ 12,00,000 - ₹ 36,00,000 per year

    Department:ClinicalLocation:APAC-India-IT Delivery Center HyderabadDescriptionPlease provide the job description for the role. The global job description template is available here: Role expectationsIn this role, you will…Deliver ResultsAchievement of Monthly, Quarterly and Annual Clinical Plans and sales target for India or markets responsible for by...

  • Clinical Documentation Specialist

    7 days ago

    Hyderabad, Telangana, India Mancer Consulting Services Full time ₹ 20,00,000 - ₹ 25,00,000 per year

    Major Responsibilities:Manage multiple CDI teams and leads; drive quality, efficiency, and complianceDefine and implement standardized workflows aligned with enterprise goalsPartner with US and India leadership on training, reporting, and process improvementsLead team hiring, onboarding, training plans, and capability enhancementConduct regular quality...