Senior Clinical Administrative Coordinator – Medical Coding
Location: Hyderabad, Telangana, India
Job Category: Medical & Clinical Operations
Requisition Number: 2344033
Company: Optum
About the Organization
Optum is a global healthcare enterprise focused on improving health outcomes through technology-enabled care delivery, pharmacy benefits management, and data-driven insights. The organization fosters a culture of inclusion, continuous learning, and professional growth while advancing healthcare optimization worldwide.
Job Overview
The Senior Clinical Administrative Coordinator – Medical Coding (Prepay Coding Investigation Consultant) plays a critical role in investigating and resolving healthcare fraud, waste, and abuse cases. This position involves comprehensive review of prepay claims, associated medical records, and coding guidelines to ensure payment accuracy and regulatory compliance.
The role requires independent decision-making, analytical expertise, and the ability to mentor junior team members. The incumbent collaborates with internal and external stakeholders, including providers, legal teams, and clients, to support accurate clinical coding investigations and operational excellence.
Key Responsibilities
Prepay Claims Review & Investigation
Review prepay claims alongside medical records to validate payment accuracy.
Apply CPT and ICD coding guidelines in accordance with regulatory and contractual standards.
Analyze clinical documentation to identify discrepancies and potential fraud or abuse.
Maintain continuous monitoring of claim inventory to meet defined performance targets.
Regulatory & Stakeholder Engagement
Participate in regulatory meetings and provider discussions.
Collaborate with legal teams, advocates, and client representatives for case resolution.
Provide expert coding guidance related to CPT investigations.
Operational Excellence & Compliance
Support internal and cross-functional projects as required.
Ensure adherence to employment terms, corporate policies, and regulatory directives.
Maintain high standards of documentation, data integrity, and compliance.
Deliver mentoring and feedback to junior staff on complex coding matters.
Required Qualifications
Graduate of a minimum 4-year Allied Medical Health program.
Certified Professional Coder (CPC) certification.
Minimum 1 year of clinical or coding experience (hospital, surgical, or clinic setting).
Minimum 1 year of BPO experience.
Strong working knowledge of CPT and ICD coding standards.
Proficiency in PC-based software applications.
Demonstrated analytical thinking, problem-solving, and critical decision-making skills.
Preferred Qualifications
Registered Nurse, Physiotherapist, Radiologic Technologist, or Pharmacist background.
Experience in health insurance billing and coding processes.
Strong prioritization and multitasking abilities.
Proven teamwork and collaboration skills.
Excellent written and verbal communication skills.
Experience Required
Minimum 1–2 years of relevant clinical and coding experience, including exposure to healthcare claims review and BPO operations.
Why Join This Role?
This position offers an opportunity to work in a high-impact healthcare compliance environment, contribute to fraud prevention initiatives, and strengthen expertise in medical coding investigations within a global healthcare framework.
Keywords: Senior Clinical Administrative Coordinator Jobs in Hyderabad, Medical Coding Jobs India, CPC Certified Jobs, Healthcare Fraud Investigation Careers, Clinical Coding Specialist Roles, Prepay Claims Review Jobs India.
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