Subject Matter Expert - Clinical Specialist

About the role

The Clinical Specialist serves as a bridge between clinical documentation and revenue cycle operations, ensuring accurate medical record review, coding support, charge capture validation, payer compliance, and denial prevention. This role collaborates with healthcare providers, coders, billing teams, and payers to optimize reimbursement while maintaining compliance with US healthcare regulations and payer guidelines.

What you'll do

• Review medical records to ensure completeness, accuracy, and compliance with payer requirements
• Identify documentation gaps that may impact coding accuracy and reimbursement
• Support Clinical Documentation Improvement (CDI) initiatives
• Educate providers on documentation best practices
• Analyze claims for documentation-related denials and underpayments

What you need

• 2–5 yrs of experience
• Medical coding
• Cash flow
• Communication
• GNM or B.Pharm or M.Pharm