Prospective Clinical Reviewers

Job Description:

Prospective Clinical Reviewer (LLM Training)

Location: Hyderabad
Experience: 3+ Years
Qualification: RN/USRN or MBBS

Job Summary

Eclat Health Solutions is hiring experienced clinical reviewers to support AI/LLM training for prospective risk adjustment workflows. The role involves reviewing longitudinal medical records, identifying clinically supported suspected conditions, validating AI-generated outputs, and providing structured clinical feedback to improve model accuracy.

Key Responsibilities.

• Review medical records, physician notes, labs, medications, and diagnostic findings.
• Identify clinically supported suspected conditions using CDI and TAMPER principles.
• Validate and refine AI/LLM-generated suspect conditions.
• Differentiate active conditions from historical, resolved, or unsupported findings.
• Document clinical evidence and rationale for identified suspects.
• Collaborate with Clinical, Coding, Quality, and AI teams to improve model performance.

Required Skills & Experience

• RN/USRN or MBBS qualification.
• Minimum 3 years of experience in CDI, medical record review, utilization review, quality review, or related clinical review functions.
• Strong understanding of chronic disease processes and clinical documentation.
• Working knowledge of ICD-10-CM terminology and documentation requirements.
• Experience reviewing outpatient physician records and longitudinal medical records.
• Strong analytical, clinical reasoning, and communication skills.

Preferred

• Experience in Risk Adjustment, HCC Coding, Prospective CDI, or Suspecting.
• Knowledge of CMS-HCC methodologies.
• CRC, CCDS, or CDIP certification.
• Experience with AI-assisted clinical review or validation projects.

Apply if you have strong clinical review expertise and are interested in contributing to next-generation AI-driven healthcare solutions.

Name :- Vinay HR

Contact No :- [phone removed]