Clinical Documentation & Coverage Policy Analyst (Outpatient)
- Emcore Global
- 3 - 7 years
- Hyderabad
- 1 month ago
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Job Description
Location: Hyderabad, India
Company: Emcore Global India LLP
Preferred Backgrounds: RCM (US Healthcare), USRN, BPT, BHMS, BSc Nursing, OP CDI, Clinical Review
Work Type: Full-time, On-site or Hybrid
Shift: US shift (partial overlap acceptable)
Job Overview
We are seeking a sharp and clinically savvy professional to join our Coverage Policy & Documentation Review team. This role is ideal for someone who has worked on the intersection of medical records, payer policies (LCDs/NCDs), and CPT/ICD coding. If youve ever handled complex denials, appeals, or chart reviews, and are familiar with CMS language, this role is for you.
You will help assess whether outpatient procedures (like pain management interventions) meet medical necessity and coverage guidelines issued by Medicare and other payers. You will be working closely with US teams building AI-based tools to improve healthcare reimbursement outcomes.
Key Responsibilities
- Analyze physician documentation, procedure notes, and records to assess if they meet payer coverage criteria (LCD/NCD and private payer policies)
- Review CPT codes and match them against appropriate clinical indications and documentation
- Interpret and apply Medicare guidelines, medical necessity criteria, and procedure limitations
- Work with policy analysts and coders to ensure correct documentation for prior authorization and denial avoidance
- Flag clinical gaps, build documentation checklists, and escalate ambiguous cases
- Summarize findings in clear written format for internal teams and AI model training
Candidate Profile
Required:
- 3-7 years of experience in US Healthcare (RCM, Denials, Utilization Review, Clinical Chart Review)
- Strong grasp of CMS LCDs/NCDs, CPT/ICD concepts
- Clinical degree: BPT / BHMS / BSc Nursing / Life Sciences OR US healthcare certification (e.g., USRN, CCS, CCA, CPMA)
- Excellent written English and analytical skills
- Hands-on experience with denial codes, medical necessity criteria, or payer audits
Preferred:
- Experience with Outpatient CDI or Telephonic Utilization Review
- Prior work with pain management, spine, or interventional procedures
- Familiarity with EMRs (e.g., Epic, Cerner) or payer portals
Why Join Us?
- Be part of a fast-growing AI healthcare product team working on real-world impact
- Opportunity to upskill into clinical policy analysis
- Flexible work environment, cross-functional exposure, and long-term growth pathRole & responsibilities
For quicker response WhatsApp Resume to +919063520022
Job Classification
Industry: BPM / BPOFunctional Area / Department: Other
Role Category: Other
Role: Other
Employement Type: Full time
Contact Details:
Company: Emcore GlobalLocation(s): Hyderabad
Keyskills: clinical review Cpt Coding US Healthcare RCM Medical Coding CPT Medical Records outpatient CDI Cdi OP Coding ICD Medical Terminology
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Emcore Global
At Emcore Global India our primary goal is to creatively tackle workforce challenges for US Healthcare provider organisation. We achieve this by optimizing the workforce's productivity and capacity and offering alternative delivery services worldwide to address labor cost and shortage challenges
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