Medical Coder

Orcapod Consulting Services; Hyderabad; Hybrid; INR 400,000 - 550,000; Full time

Job summary

Optum in Hyderabad is seeking a Medical Coder with CPC certification. Fresher to 4 years of experience preferred, with emphasis on non-HCC coding and specialty areas. Immediate to 30 days notice period is noted.

Qualified candidates include graduates with CPC certification or allied medical graduates (BAMS/BUMS/BHMS/Nursing/Physiotherapy/Dental) who are CPC certified. Prior corporate exposure is valued but not mandatory.onsultant roles may involve compliant processing and data handling.

Qualifications

• Graduation in any field; CPC certification preferred.
• 1 year corporate experience for BSc Nursing/BDS candidates.
• CPC certification mandatory for freshers or as stated.
• Experience in non-HCC medical coding; specialty coding preferred.

Responsibilities

• Investigate, recover and resolve claims for health plans and entities.
• Coordinate data gathering from members, providers and insurers.
• Pursue recoveries and payables on subrogation claims and file management.
• Ensure compliance with state/federal policies and contracts.

Skills

Medical coding

CPC certification

Attention to detail

Analytical skills

Education

Bachelor degree (Any Graduate)

BAMS/BUMS/BHMS/BPT/MPT

B.Sc. Nursing or BDS + 1 year experience

Tools

CPT/Diagnosis codes

Job description

Company Name- Optum

Role- Medical coder

Experience- Fresher to 4 Years

Notice Period- Immediate to 30 Days

Location- Hyderabad

Budget- 4 Lapa

CPC Certification must

Experienced Candidates: Minimum 1 year of experience in Non-HCC Medical Coding with specialty-based coding expertise - Any graduation.

If Freshers: Medical allied graduates with CPC certification.(BAMS, BUMS, BHMS, Nursing, Physiotherapy, Dental)

Description - External

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.

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

Qualifications - External

Required Qualifications:

• Graduation Any Graduate, BHMS/BAMS/BUMS/BPT/MPT (preferred)
• B.Sc. Nursing and BDS with 1 year of corporate experience
• Must be a certified coder through AAPC.
• Certifications accepted - CPC Only
• Experience Range - >1 Year (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 good Analytical & comprehension skills

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