Clinical Coordinator

Location:

Position Overview

minimizing claim deductions

Key Responsibilities

1. Clinical Documentation Verification

• Review and validate all clinical documents including

  Admission Notes, Discharge Summaries, Operative Notes, Progress Notes, Investigation Reports

  , and

  Treatment Sheets

  .
• Ensure documentation accuracy, consistency, and completeness as per TPA/insurance guidelines.
  
• Identify gaps, ambiguities, or missing information that may lead to claim deductions/denials and coordinate with treating teams to rectify them.
  
• Verify ICD/CPT coding relevance based on clinical findings and treatment.
  

2. TPA Coordination & Claim Support

• Support the TPA desk by providing timely clinical clarifications required for pre-authorization, enhancements, and final approval.
  
• Coordinate with consultants and nursing teams to obtain required clinical inputs and ensure alignment with TPA protocols.
  
• Review pre-auth and enhancement requests before submission to minimize queries and rejections.
  

3. Claim Deductions Minimization

• Analyze common reasons for TPA deductions and proactively work to eliminate documentation deficiencies.
  
• Ensure that every clinical event, procedure, and medication is adequately justified in documentation.
  
• Collaborate with billing teams to reconcile clinical documentation with billed items/services.
  
• Maintain checklists and SOPs to improve compliance and reduce revenue leakage.
  

4. Communication & Liaison

• Act as a clinical liaison between the medical team and TPAs.
  
• Communicate effectively with consultants to ensure timely updates for patient progress and case summaries.
  
• Attend TPA meetings or audits when required.
  

5. Compliance & Quality Assurance

• Ensure adherence to hospital policies, NABH standards, and TPA/insurance guidelines.
  
• Maintain high-quality clinical records for audit-readiness.
  
• Support quality initiatives for improving documentation accuracy and reducing claim disputes.
  

Skills & Competencies

• Strong knowledge of hospital clinical workflows and TPA/insurance procedures.
  
• Good understanding of medical terminology, ICD/CPT coding, and treatment protocols.
  
• Excellent communication and coordination skills.
  
• High attention to detail with the ability to identify documentation gaps.
  
• Proficiency in MS Office and hospital information systems (HIS).
  

Preferred Profile

• BDS/BHMS/BAMS graduate with prior experience in

  TPA coordination, medical documentation, clinical review, or medical coding

  .
• Experience in multispecialty hospital environments preferred.
  
• Ability to interact effectively with doctors and clinical staff.
  

Why Join SPS Hospitals?

• Opportunity to work in a leading multi-specialty healthcare institution.
  
• Exposure to diverse clinical cases and strong professional learning.
  
• Role directly contributes to revenue protection and operational excellence.