Hrishikesh Sarma

BAMS graduate and Medical Officer with clinical experience as a Clinical Physician and current experience at Medi Assist in medical case review, pre-authorization and claims-related clinical scrutiny. Experienced in reviewing medical and surgical cases, assessing clinical documentation and medical necessity, validating packages against clinical findings, and identifying documentation discrepancies. Detail-oriented and quality-focused, with exposure to PPD and CPD processes and NHA-related healthcare operations.

Medical Officer – PPD & CPD / Medical Claims Review - Medi Assist

(2026-06-15)

• Review medical and surgical cases from a clinical and medical-necessity perspective.
• Evaluate pre-authorization requests and supporting clinical documents, investigation reports, diagnosis and treatment plans.
• Scrutinize package selection and identify mismatched, inappropriate or inadequately supported packages.
• Ensure package decisions are aligned with documented clinical findings and appropriate medical justification.
• Identify incomplete, inconsistent or conflicting documentation and raise queries/seek clarification when required.
• Review surgical procedures for appropriate procedure selection and supporting clinical evidence.
• Assess hospitalization and treatment-related cases with attention to diagnosis, investigations, treatment course and clinical progression.
• Support PPD and CPD medical review processes while maintaining accuracy, consistency and turnaround-time requirements.
• Identify potential discrepancies between the patient's clinical condition, submitted documentation and requested package/procedure.
• Coordinate with hospital/concerned teams for additional documentation or clarification and support quality decision-making.

Clinical Physician

(2025 - 2025)

• Conducted clinical assessment of patients, including presenting complaints, history and examination findings.
• Reviewed investigation reports and correlated clinical findings to support diagnosis and management.
• Assisted in treatment planning and patient-focused clinical decision-making.
• Maintained clinical documentation and developed practical experience in evaluating a range of medical conditions.

Bachelor of Ayurvedic Medicine and Surgery - BAMS - Rajiv Gandhi University of Health Sciences (2025)