Senior Clinical Administrative Coordinator
Company: Optum (UnitedHealth Group)
Location: Noida, Uttar Pradesh, India
Department: Medical & Clinical Operations
Job Type: Full-Time
Requisition Number: 2347866
Experience Required: Minimum 1–3 Years in Medical Coding, Clinical Operations, Healthcare Claims Review, or Related Healthcare Roles
Education: Graduate Degree in Allied Medical Health (Nursing, Physiotherapy, Radiologic Technology, Pharmacy, or Related Healthcare Discipline)
About Optum
Optum, a part of UnitedHealth Group, is a global healthcare services and technology company focused on improving health outcomes through innovation, data-driven insights, and advanced healthcare solutions. The organization connects patients, providers, and healthcare systems through technology-enabled services that improve care delivery, optimize pharmacy benefits, and enhance access to healthcare resources.
With a strong global presence, Optum works to improve healthcare systems while supporting professionals who are committed to advancing patient care and operational excellence in the healthcare industry.
Job Overview
Optum is seeking a Senior Clinical Administrative Coordinator to support healthcare claims review and medical coding investigation activities within the Medical & Clinical Operations team. This role involves reviewing prepayment claims, analyzing medical records, and ensuring compliance with healthcare coding standards and payer policies.
The role focuses on identifying potential discrepancies in medical claims, supporting fraud and abuse investigations, and ensuring accurate reimbursement processes. The position also provides guidance to team members on complex coding cases and collaborates with internal and external stakeholders to resolve claims-related issues.
Key Responsibilities
Healthcare Claims Review and Coding Investigation
Review prepayment healthcare claims alongside supporting medical records to verify payment accuracy.
Analyze CPT coding guidelines, payer policies, and contractual agreements relevant to clinical claim reviews.
Identify inconsistencies or potential cases of healthcare fraud, waste, or abuse in medical claims.
Clinical Coding and Documentation Analysis
Evaluate clinical documentation and medical records to ensure appropriate coding practices.
Provide guidance on CPT coding standards and coding-related queries during investigation processes.
Ensure compliance with healthcare coding regulations and payer requirements.
Stakeholder Coordination and Issue Resolution
Participate in meetings with clients, healthcare providers, legal representatives, and internal teams to address claim disputes and coding concerns.
Collaborate with internal departments and external stakeholders to resolve claim-related inquiries.
Assist in managing provider communications related to coding investigations.
Project and Operational Support
Support internal and external projects related to healthcare claims analysis and coding investigation processes.
Analyze operational data and contribute to performance improvement initiatives.
Continuously monitor claim inventories to ensure adherence to defined service level agreements and performance targets.
Team Collaboration and Mentorship
Provide mentoring and guidance to team members on complex coding investigations and claim review processes.
Assist colleagues with problem-solving related to challenging clinical coding scenarios.
Contribute to team knowledge sharing and operational improvements.
Required Skills and Competencies
Strong knowledge of medical coding standards including CPT and ICD classification systems.
Analytical skills to review medical documentation and identify coding discrepancies.
Critical thinking and problem-solving abilities in healthcare claims investigations.
Strong attention to detail and accuracy in clinical documentation review.
Effective communication and stakeholder management skills.
Proficiency in computer-based applications and healthcare data systems.
Professional Requirements
Graduate degree in Allied Medical Health such as Nursing, Physiotherapy, Radiologic Technology, Pharmacy, or related healthcare disciplines.
Certified Professional Coder (CPC) certification preferred or willingness to obtain certification through AAPC if required.
Minimum 1 year of experience in clinical coding, medical claims review, or healthcare operations.
Experience working in BPO healthcare services or insurance-related healthcare operations is preferred.
Familiarity with healthcare insurance billing and medical coding practices is advantageous.
Why Join Optum
Optum provides healthcare professionals with opportunities to work at the intersection of healthcare, data, and technology. Employees benefit from career development programs, global exposure, and a collaborative work culture focused on improving health outcomes and advancing healthcare innovation.
Job Location
Noida, Uttar Pradesh, India.
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 :
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Delhi | India | New Delhi | PAN-India |Assam :
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Hajipur | Patna |Kerala :
Kannur | Kochi | Malappuram | Thiruvananthapuram | Trivandrum |Pondicherry (Puducherry) :
Pondicherry (Puducherry) |Jharkhand :
Ranchi |Sikkim :
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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Anchorage | Barrow | Bethel | Juneau | Sitka | Wrangell |Massachusetts :
Andover | Billerica | Boston | Cambridge | Devens | Lexington | Massachusetts | Medford and Somerville | Rockland |Wisconsin :
Appleton | Kenosha | Pleasant Prairie | Portage | Waukesha |United states :
Arizona | Buffalo Grove | Clayton | Downers Grove | fairmont | Georgia | Keene | Michigan | Mt. Pleasant | New Jersy | OH | Piedmont | Salisbury | United States | Whitesboro | Winston-Salem |Georgia :
Atlanta | Augusta | Rome |Maine :
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Bend | Coquille | Corvallis | Eugene | Florence | Grants Pass | John Day | Lake Oswego | Lakeview | Portland | Reedsport | Roseburg | Salem | Springfield | Woodburn |Wyoming :
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Birmingham |Virginia :
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Chandler | Kingman | Lake Havasu City | Mesa | Peridot | Phoenix | Surprise | Tempe | Tucson | Yuma |South Carolina :
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Concord | Lumberton | North Carolina |Michigan :
Detroit | Houghton Lake | Macomb | Southfield |North Dakota :
Dickinson |Minnesota :
Duluth | Eden Prairie | Fridley | Hibbing | Maple Grove | Minneapolis and St. Paul, Minnesota. | Minnetonka | St.Paul |Kentucky :
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Fort Smith |Kington :
Frank Scottile Blvd |Missouri :
Fulton | Milan | St. Louis |United States :
Hawai | kentucky | Sylmar | Woonsocket |Nebraska :
Hebron | Nebraska City |Hawaii :
Hilo | Honolulu |Tennessee :
Knoxville | Memphis | Nashville |Louisiana :
Lake Charles | Shreveport |Nevada :
Las Vegas | Tonopah | Tonopsh | Virginia |New Hampshire :
Lebanon | Macon | Manchester |Portugal :
Lisbon | Oeiras | Portugal |WI :
Madison | Wausau |Republic of Mexico :
Mexico |northeastern :
New Hampshire |Oklahoma :
Oklahoma City |Puerto Rico :
San Juan |Albama :
Tuscaloosa |D.C :
Washington |Delaware :
Wilmington |North Rhine Westphalia :
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Saarbrucken |Switzerland :
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Budapest |BULGARIA :
Bulgaria | Vedant |Denmark :
Copenhagen | Denmark |Europe :
Europe | France | Latvia | Lendava | Leuven | Poland | Slovenia | Spain |Finland :
Finland |Istanbul :
Istanbul | Turkey |Norway :
Norway | NOrway |Romania :
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Brinny | Ringaskiddy |Carlow :
Carlow |Republic of Ireland :
Cork | Dublin | Limerick | Waterford |Ulster :
Donegal |Meath :
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China | Quarry Bay |Liaoning :
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Netherlands |Remote Australia :
Arkansas | Remote Australia |New South Wales :
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Nedlands |Queensland :
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South Yarra |United Kingdom :
England | Harlow | Leeds | London | Maidenhead | Salt Lake City | Stevenage | Stirling | United Kingdom |North Yorkshire :
Harrogate |South Yorkshire :
Sheffield |Oxfordshire :
Witney |Ontario :
Renfrew | Mississauga | Richmond Hill | Australia | North York | Uxbridge |Canada :
Canada |Quebec :
Montreal |Brussels :
Brussels |Antwerp :
Heist op den Berg |Flemish Brabant :
Zaventem |South America :
Peru | Argentina |Brazil :
Brazil | Sao paulo |Attica :
Koropi | Athens |Greece :
Greece |North Island :
Auckland |New Zealand :
New Zealand |Austria :
Austria |Vienna :
Vienna |Catalonia :
Barcelona |Madrid :
Madrid |Cebu Province :
Cebu City |Philippines :
Manila |Croatia :
Croatia |Zagreb :
Zagreb |Estonia :
Estonia | Tartu |Harju County (Maakond) :
Tallinn |Hà Nội :
Hà Nội | Hanoi |Ho Chi Minh :
Ho Chi Minh City |Italy :
Italy |Lombardy :
Rho |Jakarta :
Jakarta |East Java :
Surabaya |Japan :
Saitama | Japan |Tokyo :
Otemachi |North Ostrobothnia :
Oulu |Southwest Finland (Varsinais-Suomi) :
Turku |Remote Korea :
Remote Korea |Republic of Korea :
Seoul |Kazakhstan :
Almaty |Republic of Thailand :
Bangkok |Israel :
Netanya | Be'Er Sheva | Kfar Saba | Yavne | Tel Aviv |Remote :
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Bucharest |Buenos Aires :
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Cairo |Mexico :
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Kyiv |Lima Region :
Lima |France :
Paris | Lyon |South Africa :
Midrand | South Africa |Nišava District :
Niš |Bohemia :
Prague |Chile :
Santiago |Bosnia and Herzegovina :
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Singapore |Sofia City :
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