▷ 15h Left ROI Analyst

6 days ago

Gurugram India Optum Full time

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.

The ROI Audit plays a key role in the Release of Information (ROI) workflow by managing the end-to-end process of auditing Release of Information (ROI) requests and performing daily invoicing. The process begins with reviewing incoming ROI requests to ensure they meet compliance standards, including verifying the presence of Date of Service (DOS), checking for patient and record availability, and applying appropriate classifications.

Each request is audited for accuracy and completeness, following strict naming conventions and documentation protocols. Audit results are recorded and placed as defined for tracking and reporting. Once all requests are processed, the specialist performs end-of-day invoicing for completed audits, ensuring timely and accurate billing. This role requires solid attention to detail, familiarity with medical documentation, and a commitment to maintaining data integrity and confidentiality.

Primary Responsibilities:

- Receive, log, and track incoming requests for medical records
- Verify the validity of requests (e.g., proper authorization, identity verification)
- Ensure all ROI requests are processed in compliance with HIPAA and internal policies
- Complete the day-to-day activities in the Release of Information (ROI) area
- Work on the Insurance denials and share the related Medical Records with the Insurance Company
- Perform end-of-day invoicing for all completed ROI requests
- Collaborate with team to resolve discrepancies and improve audit workflow
- 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 regard 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:

- Bachelor's degree (preferably in life science) or equivalent
- 3+ years in US healthcare
- Solid knowledge of RCM, HIPAA, UB04 & HCFA 1500 and Medical Terminologies
- Preferred Applications Experience: Cerner, eFR and Powerchart
- Proficiency in MS Office tools including Excel, Word, and Forms
- Open to work from office as per business requirements

Soft Skills:

- Ability to multi-task
- Excellent Communication and Time Management
- Problem solving, Critical Thinking, Organizational and Analytical skills
- Active listening skills
- Team building

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