Job Title: Senior Clinical Administrative Coordinator
Company: Optum / UnitedHealth Group
Location: Noida, Uttar Pradesh, India
Employment Type: Full-time
Category: Medical & Clinical Operations
Role Overview
The Senior Clinical Administrative Coordinator (Prepay Coding Investigation Consultant) is responsible for investigating and resolving healthcare fraud and abuse, reviewing medical claims, ensuring coding accuracy, and providing guidance and mentoring on complex cases. The role involves collaboration with internal and external stakeholders and adherence to regulatory and company standards.
Key Responsibilities
Claim and Case Review:
Review prepay claims alongside corresponding medical records to determine payment accuracy.
Analyze applicable policies, CPT guidelines, and contracts for clinical review.
Participate in regulatory meetings with clients and provider meetings as needed.
Monitor claim inventory to meet performance targets.
Project Support & Data Analysis:
Conduct internal and external projects as required, analyzing data and resolving issues.
Provide guidance on CPT coding relevant to investigations.
Team & Stakeholder Collaboration:
Mentor junior staff and provide explanations/feedback on complex cases.
Coordinate with internal teams, providers, legal, and advocacy teams to ensure compliance and resolution.
Compliance & Policy Adherence:
Follow company policies, employment directives, and contractual terms.
Ensure adherence to regulatory requirements and maintain accurate documentation.
Required Qualifications
Graduate of 4-year Allied Medical Health program (RN, Physiotherapy, Radiologic Tech, or Pharmacist preferred).
Certified Professional Coder (CPC).
CPT & ICD coding experience or ability to pass AAPC CPC Certification provided by Optum.
Experience: Minimum 1 year clinical/coding experience (surgical, hospital, clinic) and 1 year BPO experience.
Proficiency with PC-based software.
Strong critical thinking, problem-solving, and analytical skills.
Preferred Qualifications
Graduates of Allied Medical Health disciplines.
Experience in health insurance billing/coding.
Proven ability to prioritize, manage multiple tasks, and work effectively in a team.
Excellent oral and written communication and presentation skills.
Uttar Pradesh :
Agra | Gajraula | Gautam buddha Nagar | Ghaziabad | Gorakhpur | Greater Noida | Jhansi | kanpur | Lucknow | Mathura | Noida | Park City | Prayagraj | Satyamev | Varanasi |Gujarat :
Ahmedabad | Ankleshwar | Baroda | Bharuch | Gandhinagar | Gujarat | Halol | Jhagadia | Mehsana | surat | Tarasadi | Vadodara | Vapi |Maharashtra :
Airoli | Ambernath | Amravati | Aurangabad | Dhule | Dombivali | Jalgaon | Kolhapur | Kurkumbh | Kurla | Madhapur | Mumbai | Nagpur | Nashik | Navi Mumbai | parel | Pune | Pune city | Shirpur | Tandalja | Tarapur | Thane | Vikhroli | Yerawada |Haryana :
Ambala | Gurugram | Haryana | Hisar | Kurukshetra | Panchkula | Rohtak | Shivalik |Punjab :
amritsar | Bathinda | Bela | Chandigarh | ludhiana | Moga | Mohali | Patiala | Phagwara | Rajpura |Andra Pradesh :
Anakapali | Anantapur | Bhimavaram | Chittoor | Guntur | Gurgaon | Kakinada | Mangalagiri | Nellore | Pydibimavaram | Tirupathi | Vijayawada | Visakhapatnam |Tamil Nadu :
Annamalainagar | Chennai | Coimbatore | Erode | Madurai | Nagercoil | Ooty | Pudupakkam | Srivilliputtur | Tamil nadu | Tiruchirappalli | tiruppur | Trichy | Vellore | Yogyakarta |Himachal Pradesh :
Baddi | Solan |Rajasthan :
Banasthali | Bhiwadi | Jaipur | Pilani | Udaipur |Karnataka :
Bangalore | Belgaum | Bengaluru | B.G Nagara | Bommasandra | Colorado | Czech Republic | Karnataka | Mangaluru | Mysore | Udupi |Madhya Pradesh :
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Bilaspur | Eot Municipality | Raipur |Uttarakhand :
Dehradun | Halifax | Nainital | Rishikesh | Roorkee |Delhi :
Delhi | India | New Delhi | PAN-India |Assam :
Dibrugarh | Diburghar | Guwahati |West Bengal :
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Hajipur | Patna |Kerala :
Kannur | Kochi | Malappuram | Thiruvananthapuram | Trivandrum |Pondicherry (Puducherry) :
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Rangpo |India :
Siliguri |Illinois :
Abbott Park | Bloomingdale | Champaign | Chicago | Deerfield | Glenview | Lake Forest | Lombard | Naperville | Norridge | Park RIdge | Round Lake |Maryland :
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Netherlands |Remote Australia :
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South Yarra |United Kingdom :
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Canada |Quebec :
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Brazil | Sao paulo |Attica :
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Greece |North Island :
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Japan | Saitama |Tokyo :
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