Job
Description
Company Description We at Vitraya, quietly building something at the intersection of AI, insurance, and healthcare claims, Hospitals lose thousands of crores every year due to denied or delayed claims and with increasing govt spending, the figure going to be crazy high. As a technology-first company, we're solving critical challenges in the Indian healthcare market, including lack of transparency, high rejection rates, and inefficient claims processing. Our mission is to transform how hospitals & insurance manage their claims processing, enabling them to focus on what matters most—patient care & experience Role Description You will be the clinical cornerstone of our revenue cycle operations, leading a specialized team of medical experts who bridge the gap between clinical documentation and financial outcomes. You will harness your medical expertise and leadership abilities to ensure clinical accuracy in claims processing, minimize denials through expert medical validation by helping us build cutting edge tools and services, and build trust-based relationships with healthcare providers, insurance partners, and government schemes. This role demands a unique blend of clinical knowledge, operational leadership, and technological adaptability—all while embodying our core values of empathy and compassion. You'll be instrumental in transforming how hospitals in India manage their claims, ultimately improving healthcare accessibility and financial transparency for patients. This is a role for the curious and forward-thinking medical professional who is excited about how AI and technology are reshaping healthcare operations and wants to be at the forefront of this transformation. Key Responsibilities Clinical Leadership & Team Management •Lead, mentor, and develop a high-performing team of medical experts •Establish clinical standards and protocols for claim validation, documentation review, and denial prevention •Oversee the clinical training and continuous education of medical experts, ensuring they stay current with coding guidelines and medical necessity criteria •Foster a culture of clinical excellence, attention to detail, and continuous improvement •Manage team performance through data-driven metrics while maintaining quality standards •Coordinate seamlessly between on-ground medical experts and remote team members across our locations •Autonomously build and scale your team with minimal oversight, demonstrating your ability as a self-starter and natural leader Clinical Claim Validation & Denial Management •Serve as the ultimate clinical authority for complex claim reviews, providing expert medical opinions on challenging cases •Develop and implement clinical documentation improvement strategies to prevent denials and optimize reimbursement •Collaborate with hospital clinical teams to resolve documentation gaps and clinical queries •Lead the clinical aspects of appeals management, providing compelling medical justification for overturning denials •Establish trusted relationships with medical reviewers at insurance companies and government schemes •Conduct regular clinical audits to identify patterns in denials and implement preventive measures Technology Integration & Innovation •Partner with our technology team to enhance our AI prediction engine for identifying potential denial flags •Provide clinical expertise for the development and refinement of our AI Engines and LLMs •Champion the adoption of AI-assisted clinical documentation review tools among your team •Develop clinical decision support frameworks that can be integrated into our technology platform •Identify opportunities for automation in clinical validation processes while maintaining quality and compliance •Translate complex clinical concepts into structured data elements that can be leveraged by our technology systems •Demonstrate curiosity and enthusiasm for how AI is reshaping medical claim processing, contributing ideas for technological innovation Market-Facing & Thought Leadership •Serve as a spokesperson for us at industry events, webinars, and conferences •Participate in sales presentations to showcase clinical expertise and build credibility with potential hospital partners •Create and deliver educational content on best practices in clinical documentation and denial prevention •Conduct webinars and training sessions for hospital partners on optimizing clinical documentation for claims •Contribute to thought leadership content, including articles, white papers, and case studies •Represent our brand clinical perspective in media interactions and PR opportunities •Build relationships with key opinion leaders in the healthcare industry Qualifications & Experience Required Qualifications •Medical degree (MBBS, BDS, BHMS, or equivalent) with valid registration •7+ years of clinical experience, with at least 3 years in healthcare administration, revenue cycle management, or related fields •Proven experience managing teams of medical professionals in a performance-driven environment •Strong understanding of medical coding, clinical documentation requirements, and healthcare reimbursement •Experience with both government healthcare schemes (MAA, PMJAY, RGHS, CGHS) and private insurance in India •Demonstrated ability to translate clinical knowledge into operational excellence •Excellent communication skills with the ability to explain complex medical concepts to diverse stakeholders •Demonstrated ability to operate autonomously and drive results with minimal supervision Preferred Qualifications •Additional qualifications in healthcare management, health informatics, or related fields •Experience with AI-assisted clinical documentation or coding systems •Background in clinical denial management and appeals •Experience working with multiple medical specialties and case types •Knowledge of healthcare technology platforms and electronic medical records •History of implementing clinical quality improvement initiatives •Experience in startup or high-growth environments •Public speaking experience, including presentations, webinars, or conference talks •Experience participating in sales processes or business development activities Core Competencies Clinical & Technical Expertise •Deep understanding of clinical documentation requirements across specialties •Knowledge of medical necessity criteria and evidence-based practice •Familiarity with ICD-10, CPT/HCPCS coding principles •Understanding of healthcare reimbursement methodologies •Ability to leverage technology for clinical decision support •Aptitude for translating clinical knowledge into operational processes •Curiosity and enthusiasm for AI and emerging 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