Medical Validator

About the role

The Medical Validator ensures that all clinical documentation and claim information are accurate, complete, and medically justified before submission to the Revenue Cycle Management team. Acting as a quality gate, the role safeguards compliance and supports optimal reimbursement while protecting patient safety.

Key responsibilities

• Review inpatient, outpatient, emergency and day‑case records for completeness and clinical accuracy.
• Validate diagnoses, procedures, investigations, medications and treatment plans against medical necessity criteria.
• Check claims for quantitative consistency – diagnoses codes, procedure codes, length of stay, consumables and billed items.
• Identify missing or unsupported documentation and coordinate timely corrections with physicians and clinical staff.
• Support denial prevention by flagging gaps in documentation or medical justification before claim submission.
• Collaborate with coding, billing, and RCM teams to improve claim quality and submission accuracy.
• Participate in fraud, waste and abuse investigations, providing corrective actions while maintaining patient care standards.

Required profile

• Bachelor’s degree in medicine (MBBS) or equivalent healthcare qualification; physicians, dentists or pharmacists are preferred.
• 2–3 years of experience in clinical practice, medical claims management, medical review or revenue cycle operations.
• Relevant certifications in healthcare quality, medical coding or health insurance are advantageous.

Required skills

• Medical coding
• Revenue cycle management