Clinical Investigator

Optum (UnitedHealth Group) · Healthcare & Pharma

Hyderabad, Telangana, India
On-site
Posted yesterday
Healthcare & Life Sciences

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About the job

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT or diagnosis codes, CMS guideline along with referring to client specific guidelines and member policies

Adherence to state and federal compliance policies and contract compliance

Assist the prospective team with special projects and reporting

Coordinate with all team members and share recent process related updates

Comply with all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements.

Required Qualifications:

Graduation - Any Graduate, BHMS/BAMS/BUMS/BPT/MPT (preferred)

B.Sc. Nursing and BDS with 1+ years of corporate experience

Certified coder through AAPC

Certifications accepted - CPC Only

1+ years of experience (if not medical graduate) - specialty coding such as E&M, surgery, anesthesia etc., but not only HCC

Extensive work experience within own function

Proven attention to detail & Quality focused

Proven excellent analytical & comprehension skills

Preferred Qualifications:

Claims processing experience

Health Insurance knowledge, managed care experience

Knowledge of US Healthcare and coding

Medical record familiarity

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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