Clinical Investigator

Orcapod Consulting Services; Chennai District; Sur place; INR 600 000 - 900 000; Plein temps

Résumé du poste

Orcapod Consulting Services is seeking an experienced professional to prevent payment of potentially fraudulent or abusive claims using medical expertise, CPT/diagnosis codes, and client guidelines.

The role involves ensuring adherence to compliance policies, supporting special projects, and working with minimal established procedures. The ideal candidate will have claims processing experience and knowledge of US healthcare and coding.

Qualifications

• Claims processing experience (preferred).
• Knowledge of health insurance and managed care is preferred.
• Knowledge of US healthcare and coding.
• Familiarity with medical records and documentation.

Responsabilités

• Prevent payment of potentially fraudulent and/or abusive claims using medical expertise, CPT/diagnosis codes, CMC guideline and client policies.
• Adherence to state and federal compliance policies and contract requirements.
• Assist the team with special projects and reporting.
• Work is frequently completed without established procedures; may operate independently.

Connaissances

Claims processing

Health Insurance knowledge

US Healthcare knowledge

Medical record familiarity

Description du poste

Primary Responsibilities:

• Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC 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
• Work is frequently completed without established procedures
• Works independently
• May act as a resource for others
• May coordinate others' activities
• 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

Preferred Qualifications:

• Claims processing experience
• Health Insurance knowledge, managed care experience
• Knowledge of US Healthcare and coding
• Medical record familiarity

Qualifications - Internal

Eligibility
To apply to an internal job, employees must meet the following criteria:

• Minimum 12 months in the current role
• Not on Active CAP at the time of applying for the IJP
• Employees at SG 22 and SG 23 are eligible
• Employees must notify their Current Manager before applying for the IJP
• Last Common Review rating should be Meeting Expectations or Exceeding Expectations