Clinical Investigator

3 days ago

Hyderabad Telangana, India Optum Full time

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.**

The process involves identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates 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.

**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
- 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**:

- Medical degree - BHMS/BAMS/BUMS/BPT/MPT/B.Sc. Nursing
- Basic computer skills
- Attention to detail and quality focused
- Good analytical and comprehension skills

**Preferred Qualifications**:

- Health Insurance knowledge, managed care experience
- Claims processing 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._

  • Clinical Reviewer/clinical Invesigator

    3 days ago

    HITEC City, Hyderabad, Telangana, India Kotumb Full time

    We are hiring for CLINICAL INVESTIGATOR/CLINICAL REVIEWER Bsc Nurse/BPT/BDS can apply Should have exp on ICD 10 coding, CPT coding Salary upto 5LPA work location : Hyderabad Immediate joiners should have 1 year exp in US HEALTH CARE Please reach me at 9902419093 Pay: ₹400,000.00 - ₹450,000.00 per year Schedule: - Night shift **Education**: -...

  • Clinical Trials

    13 hours ago

    Hyderabad, India Advity Research Full time

    Hyderabad 02 to 06 Years Full Time - Plan and conduct investigator site selection audits and clinical trial study audits at investigator sites in accordance with applicable GCP guidelines and regulations. - Review of CRF design - Review of standard operating procedures - Issue audit reports to the investigator site staff and other concerned study personnel -...

  • Clinical Sciences Expert

    14 hours ago

    Hyderabad District, Telangana, India Novartis Full time

    7000 patients, 1200 clinical sites, 40 countries, 100+ clinical studies led by Novartis Clinical Sciences & Innovation (CS&I) last year. Who are we? We are Clinical Sciences and Innovation at Novartis. A dynamic group of Clinical Scientists who plan and execute early phase trials worldwide in general medicine. From First-in-Human to Proof-of-Concept and...

  • Clinical Coordinator

    4 days ago

    Banjara Hills, Hyderabad, Telangana, India Oval Fertility Full time

    Position Title**:Clinical Coordinator - Female** Department**:Clinical Operations** Location**:Banjara Hills, Hyderabad** Reports To**:Centre Manager** **Qualifications & Skills Required** - **Education**: BDS (Bachelor of Dental Surgery) / BAMS (Bachelor of Ayurvedic Medicine & Surgery) - preference for healthcare background. - **Experience**: 1-3 years...

  • Clinical Research Coordinator

    4 days ago

    Hyderabad, India Fusion Market Research Full time

    Records adverse event and side effect data and confers with investigators regarding the reporting of events to oversight agencies. Prepares for or participates in quality assurance audits conducted by study sponsors, federal agencies, or specially designated review groups. Identifies protocol problems, informs investigators of problems, or assists in problem...

  • Clinical Investigator

    14 hours ago

    Hyderabad, Telangana, India Optum Full time

    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,...

  • Clinical Safety Contractor

    4 days ago

    Hyderabad, India NITZ Consulting Private limited Full time

    **NITZ Consulting private Limited Inc. (“NItz”) **is committed to providing quality service in the field of pharmacovigilance to clients. Our clients range from mid-size to small pharmaceutical companies located worldwide who are engaged in developing a proprietary pipeline of novel therapies for the treatment of solid tumors and hematological...

  • Clinical Research Associate(Remote Monitoring)

    4 days ago

    Hyderabad, Telangana, India Talent Folks Full time

    **Clinical Research Associate( Work from Home)** **About the company**: **We **provide enterprise grade platforms that accelerates adoption of Kubernetes and Data. Gravity, our flagship platform, provides a simplified Kubernetes experience for developers by removing all the removing all the underlying complexities. Developers can use tailor-made workflows...

  • Associate Clinical Trial Leader

    3 weeks ago

    Hyderabad, Telangana, India Thepharmadaily Full time

    Job DescriptionResponsible for supporting, under the guidance of the Lead Clinical Trial Leader and/or Clinical Trial Leader (CTL) and the Clinical Program Leader (CPL), all aspects of TCO clinical trial(s) as assignedMajor accountabilities:- May lead studies in maintenance or in closeout phase or ongoing studies post primary database lock with the oversight...

  • Clinical Research Associate

    3 days ago

    Hyderabad, India Dr.Reddy's Full time

    ) Act as DRL’s direct contact with assigned sites, assess and ensure overall integrity of study 2) Implementation and adherence to study protocol at clinical investigational sites, and resolve site issues. Escalate issues that were unresolved to COL/PL. 3) Build and maintain relationships with investigators and site staff. 4) Facilitate and support site...