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Key Responsibilities:
- Review medical records, treatment plans, and billing documents for medical necessity and coding accuracy.
- Validate if clinical documentation supports prescribed procedures or medications.
- Prepare concise medical justifications for approval, denial, or modification of claims.
Qualifications:
- MBBS, MD, BDS, BAMS, BHMS, PharmD, or equivalent
- Active registration with a recognized medical/dental council
- Basic computer skills; familiarity with MS Office or Google Workspace
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