Conduct thorough investigations into claims to ensure accuracy and compliance with regulatory requirements.
Review medical records and documentation to assess claim validity and identify potential issues.
Analyze CPT/ICD coding guidelines and apply them to pre-payment claims.
Collaborate with cross-functional teams to resolve complex claims-related issues.
Develop and maintain expertise in clinical review processes and procedures.
Identify areas for process improvement and implement changes to increase efficiency.

Job Requirements

Certified Professional Coder (CPC) certification is required; AAPC certification is an added advantage.
Minimum 6 months of experience as a certified coder, preferably in healthcare or claims processing.
Strong analytical, comprehension, and documentation skills are essential.
High attention to detail and a quality-focused mindset are necessary.
Experience working within the healthcare/claims function is preferred.
Familiarity with US healthcare and managed care systems is desirable.
Knowledge of health insurance operations and coding workflows is beneficial.

About Company

Optum, part of UnitedHealth Group, is a global healthcare technology and services leader that focuses on improving healthcare outcomes, promoting equity, and advancing the healthcare system through data-driven insights. Employees benefit from an inclusive culture, development opportunities, and impactful work that supports healthier communities worldwide.

Disclaimer: This job description has been sourced from a public domain and may have been modified by Naukri.com to improve clarity for our users. We encourage job seekers to verify all details directly with the employer via their official channels before applying.

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Clinical Investigat