Job Title: Senior Clinical Administrative Coordinator – Medical Coding (Prepay Coding Investigation Consultant)
Requisition ID: 2344033
Location: Hyderabad, Telangana, India
Employment Type: Full-Time
Industry: Healthcare Operations | Medical Coding | Fraud, Waste & Abuse (FWA) Investigation
Optum is a global healthcare solutions organization leveraging advanced analytics, clinical intelligence, and operational expertise to improve health outcomes and optimize healthcare delivery systems. With a strong focus on regulatory compliance, coding accuracy, and fraud prevention, the organization supports healthcare payers, providers, and members worldwide.
This role offers a strategic opportunity for experienced medical coding professionals to contribute to prepayment claim investigations, regulatory compliance, and healthcare payment integrity initiatives.
The Senior Clinical Administrative Coordinator – Medical Coding functions as a Prepay Coding Investigation Consultant, responsible for reviewing prepayment claims, investigating potential healthcare fraud and abuse, and ensuring coding and billing accuracy.
This senior-level position involves detailed clinical documentation review, CPT and ICD coding validation, regulatory policy analysis, and collaboration with internal and external stakeholders. The role also includes mentoring junior team members, providing expert coding guidance, and supporting cross-functional projects related to payment integrity and compliance.
Review prepay claims alongside corresponding medical records to determine payment accuracy.
Investigate potential instances of healthcare fraud, waste, and abuse (FWA).
Utilize information from tips, member benefits, and medical documentation to document relevant investigative findings.
Provide CPT coding guidance relevant to investigative cases.
Review applicable policies, CPT guidelines, payer contracts, and clinical documentation standards.
Participate in regulatory meetings with clients.
Collaborate with providers, legal teams, and advocates regarding provider abrasion and coding disputes.
Ensure adherence to regulatory requirements and compliance frameworks.
Monitor and manage claim inventory to meet defined performance guarantees and service-level agreements.
Analyze data and contribute to internal and external projects as required.
Work independently with minimal supervision while escalating complex cases appropriately.
Mentor and provide guidance to team members on complex coding and investigation issues.
Bachelor’s degree (minimum 4-year course) in Allied Medical Health Sciences.
Certified Professional Coder (CPC) credential required.
Minimum 1+ year of clinical and/or medical coding experience in surgical, hospital, or clinical settings.
Minimum 1+ year of BPO or healthcare operations experience.
Strong knowledge of CPT and ICD coding systems (or must successfully obtain AAPC CPC certification if provided by employer).
Proficiency in PC-based software and healthcare claims systems.
Demonstrated critical thinking, analytical reasoning, and problem-solving capabilities.
Graduates in Allied Medical Health disciplines such as:
Registered Nurse (RN)
Physiotherapist
Radiologic Technologist
Pharmacist
Experience in health insurance billing, coding audits, or payment integrity review.
Ability to manage multiple priorities in a structured, deadline-driven environment.
Proven ability to work collaboratively in cross-functional teams.
Strong oral and written communication skills, including presentation capabilities.
Prepay claims review and payment integrity
CPT and ICD coding validation
Healthcare fraud, waste, and abuse investigation
Clinical documentation analysis
Regulatory compliance and payer contract review
Data-driven decision-making
Stakeholder communication and escalation management
This is a senior-level healthcare operations role requiring independent judgment, regulatory awareness, and coding expertise. The position involves collaboration with investigators, legal teams, providers, and payer clients to ensure claim accuracy and compliance with industry standards.
This role offers advanced exposure to medical coding audits, prepayment investigations, and healthcare compliance operations within a global healthcare framework. It is well-suited for certified coders seeking career growth in payment integrity, fraud prevention, and regulatory clinical operations.
Qualified professionals interested in senior medical coding and prepay investigation careers in Hyderabad are encouraged to apply.
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