Clinical Investigator

Optum; Bengaluru; On-site; INR 450,000 - 600,000; Full time

Job summary

Optum is a global health services company focused on improving health outcomes through care delivery, technology, and data. This role involves preventing fraud in medical claims, applying CPT and diagnosis coding, and ensuring CMS guidelines are followed.

The candidate will support the team with projects, maintain compliance, and coordinate updates, while complying with policies and directives to adapt to changing business needs.

Qualifications

• Certified coder through AAPC
• CPC Certification preferred
• Strong attention to detail and analytical skills

Responsibilities

• Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, CPT/diagnosis codes, CMS guidelines and client policies.
• Adhere to state and federal compliance policies and contract requirements.
• Assist the team with special projects and reporting.
• Coordinate with team members and share process updates.
• Comply with employment contracts, company policies and directives.

Skills

AAPC Certified coder

CPC Certification

Attention to detail

Analytical skills

Education

BHMS/BAMS/BUMS/BPT/MPT

B.Sc. Nursing

BDS

Job description

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 the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

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.