Freshers Clinical Specialist Job at PractoPulse

PractoPulse Healthcare Services is hiring a Clinical Authorisation Specialist (Job ID 1037) in Hyderabad. This PractoPulse job in Hyderabad is open to fresh graduates. Full-time, work from the office, night shift. Experience: 0–2 years.

About PractoPulse:

PractoPulse Healthcare Services is a healthcare revenue cycle management company headquartered in Hyderabad, India, with operations in the United States. The company specialises in medical coding, medical billing, clinical documentation, accounts receivable management, and healthcare consulting. It provides technology-driven solutions that help healthcare organisations streamline administrative operations, improve claims processing, and optimise reimbursement.

Job Details:

  • Job Title: Clinical Authorisation Specialist
  • Job ID: 1037
  • Location: Hyderabad
  • Job Type: Full-time
  • Work Mode: Work from office
  • Shift: Night shift
  • Experience: 0–2 years

Key Responsibilities:

  • Prioritisation 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 for providing 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 for assigning 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 authorisation requests and medical documentation comply with HIPAA regulations, payer guidelines, and internal quality standards.
  • Denial Management: Analyze and respond to denied authorisation 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.
  • Compliance & Quality Standards: Ensure compliance with HIPAA, payer guidelines, and internal audit standards. Maintain confidentiality of patient information.
  • Reporting: Prepare daily/weekly/monthly reports on authorisation status, TAT, denials, and approvals. Highlight process gaps and contribute to quality improvement initiatives.

Eligibility Criteria for Clinical Specialist Job:

Eligible: MBBS from India or abroad (China, Russia, Ukraine, etc.), BHMS, BAMS, BDS, MDS, BPT, MPT, Pharm D.

Required Skills:

  • MS Office (Word, Excel, PowerPoint)
  • Willingness to work night shifts from the office

CLICK HERE TO APPLY ONLINE