Clinical Investigator

1 week ago

Secunderabad, Telangana, India unitedhealth group information services Full time ₹ 5,00,000 - ₹ 10,00,000 per year

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.

Process Postpay ClinicalPrimary Responsibilities:
  • This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services.
  • Keen eye for detail.
  • Knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies.
  • 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.
  • 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.
  • Knowledge of US Healthcare and coding desirable.
  • Proven attention to detail & Quality focused.
  • Proven good Analytical & comprehension skills.
  • Basic Computer Skills.
Preferred Qualifications:
  • 6 months of clinical review experience.
  • Extensive knowledge on ISET/UNET/FACETS/COSMOS platform used to perform research as part of the clinical investigation process.
  • Claims processing experience.
  • Medical record familiarity.
  • Knowledge of ICD-10.
  • Intermediate skill level with MS Office.

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.

Apply Internal Employee Application
Locations - Primary Location: Hyderabad, Telangana, IN

`घोटाले चेतावनी: JORA एक नौकरी खोज इंजन है । हम एक भर्ती नहीं कर रहे हैं और किसी भी भर्ती प्रक्रिया का हिस्सा नहीं हैं। हमारे कार्यालय केवल ऑस्ट्रेलिया में हैं। हम नौकरी चाहने वालों से कभी संपर्क नहीं करते या चयन उद्देश्यों के लिए उम्मीदवार से कभी संपर्क नहीं करते। यदि आपको कॉल या मेल प्राप्त होता है (बाहर की ) JORA से होने का दावा करने वाले व्यक्ति से आपको प्रासंगिक प्राधिकारियों से संपर्क करना चाहिए । उस व्यक्ति के बारे में आपकी सारी जानकारी के साथ । इसके अलावा, आपको साक्षात्कार चरण में संसाधित करने के लिए भुगतान करने की आवश्यकता नहीं होनी चाहिए। JORA उम्मीदवारों से कभी पैसे नहीं मांगते।

सावधान रहें और जागरूकindia ।
सादर,
JORA टीम ।

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