Clinical Appeals and Denials

V3 Staffing; Hyderabad; On-site; INR 450,000 - 650,000; Full time

Job summary

V3 Staffing is seeking a healthcare professional with a strong clinical background to review medical documentation, assess payer denials, and prepare effective appeals within the US healthcare domain.

The ideal candidate will have hands-on experience in utilization management, medical necessity reviews, and multispecialty denials, contributing to overall quality and operational excellence.

Qualifications

• Minimum 2 years of experience in denials & appeals, utilization review, case management, or related clinical review functions.
• Experience handling multispecialty denials and appeals.
• Strong understanding of US healthcare payer guidelines and appeals processes.

Responsibilities

• Review clinical documentation and patient records for accuracy and compliance.
• Assess payer denials and prepare effective appeals.
• Contribute to quality and operational excellence in the US healthcare domain.

Skills

Clinical background

Denials & Appeals

Medical necessity reviews

Payer guidelines

Job description

Role & responsibilities

Strong clinical background with sound understanding of medical terminology, diagnoses, procedures, and treatment protocols

• Ability to review and interpret clinical documentation and patient records
• Minimum 2 years of experience in Denials & Appeals, Utilization Review, Case Management, or related clinical review functions
• Experience handling multispecialty denials and appeals
• Strong understanding of US healthcare payer guidelines, medical necessity reviews, and appeals processes

Preferred candidate profile

We are looking for healthcare professionals with strong clinical expertise and hands-on experience in managing multispecialty denials, medical necessity reviews, utilisation management, and appeals within the US healthcare domain. The role involves reviewing clinical documentation, assessing payer denials, preparing effective appeals, and contributing to quality and operational excellence.