Clinical Executive/Sr Clinical Executive

About this role

Job Title - Clinical Executive/Sr Clinical Executive

Reporting to - Team Leader/AM/DM 

Location - Bangalore 

Working Hours/ Days - 9 Hours / 5 Days a Week. Over time will be applicable

Shift - U.S Shift (2:30 PM – 11:30 AM) (3:30 PM – 12:30 AM) (Only during training 8:30 PM to 5:30 AM) 

Job description -

Review medical records and follow stringent protocols to determine whether patients meet the standards for insurance reimbursement. • Clinical review for medical necessity of identified claims.

• Documentation of clinical rationale supporting findings of the review.

• Apply clinical judgment, honed over years in acute care settings, to make responsible decisions that promote appropriate records review and applications usage while keeping resources available to those most in need.

• Review and validate all information pertaining to the claim.

• Comply with procedures, regulations, and rules in maintaining medical records.

Interacts on a continuous basis with other departments by directing activities towards positive outcomes.

Desired skill sets - Must be willing to work in US rotational shift.

Must be willing to work from Office.

MS office

Typing skills, computer skills

Good communication in English

Good analytical skills 

Any Nursing Graduates and 10+2+3 ( BSc Nursing/Post Bsc/Msc Nursing)

Minimum 0 to 3 years of clinical experience in ISO, NABH, JCI hospitals - (Not Mandatory) 

Both Ways Transportation will be provided 

Training Period - 3months to 8 Months

Work Location - Chamundi towers – Garvebhavipalya 

Salary Details - For Fresher 268,750 Per Annum / For experienced – up to 350000 

Take home salary for fresher’s - In Hand Salary will be 15484 per month and Variable of 2238 will be paid asper the performance after training.

Interview process - 1st round with TA 2 nd round with Operations.

Transportation boundary - Within 25 Km However some areas are restricted due to security reasons and Narrow Lane

Nurse review

Nurse review is a complex process, medical records are validated by a qualified and certified nurse to determine medical necessity and appropriateness of treatment for an injury performed by health care professionals to ensure accuracy of payment and avoid fraudulence: Relatedness - Identifying correlation between billed diagnosis with medical reports. The nurse can recognize the patient's priority health problem based on the patient's information and can predict the issue of the patient through clinical decision making. Compensability - Validate the injury with insured body part that can be associated with a worker's job function (illness/ injury during the course of employment