Senior Clinical Administrative Coordinator – Medical Coding | Full Time Job in Hyderabad
Company: Optum (Part of UnitedHealth Group)
Job Category: Medical and Clinical Operations
Job Type: Full-Time
Requisition Number: 2344033
Location: Hyderabad, Telangana, India (On-site)
Experience Required: Minimum 1+ Years in Clinical Coding or Healthcare Operations
Build a meaningful career in healthcare operations and medical coding with a global healthcare technology organization focused on improving patient outcomes. This role offers an opportunity to work in clinical claims review, coding investigation, fraud detection, and healthcare compliance while contributing to improved healthcare delivery and system efficiency.
Job Overview
The Senior Clinical Administrative Coordinator – Medical Coding (Prepay Coding Investigation Consultant) is responsible for reviewing and investigating healthcare claims, identifying potential fraud or abuse, and ensuring accurate medical coding and payment validation. The role involves analyzing medical records, reviewing clinical documentation, and providing coding guidance to internal teams.
As a senior-level professional, the candidate will mentor team members, support complex case investigations, and collaborate with internal and external stakeholders to maintain regulatory compliance and improve healthcare claims accuracy.
Key Responsibilities
Review prepay claims and corresponding medical records to verify payment accuracy and coding compliance.
Evaluate clinical documentation, policies, CPT guidelines, and contractual terms for claim validation.
Investigate potential healthcare fraud, waste, or abuse involving medical providers.
Document findings based on medical records, member benefits, and claim data.
Provide coding guidance to investigators, particularly related to CPT codes and investigation processes.
Participate in regulatory meetings with clients and stakeholders.
Collaborate with providers, legal teams, and healthcare advocates to resolve coding or payment disputes.
Monitor claim inventory continuously to meet performance and operational targets.
Analyze healthcare data and provide recommendations for issue resolution.
Support internal and external projects related to coding investigation and compliance.
Mentor junior team members and provide guidance on complex coding issues.
Ensure adherence to company policies, regulatory standards, and operational procedures.
Coordinate with internal and external stakeholders to facilitate client requests and operational efficiency.
Required Qualifications
Bachelor’s degree in Allied Medical Health or related healthcare discipline (minimum 4-year course).
Certified Professional Coder (CPC) certification or eligibility to obtain certification.
Minimum 1+ years of clinical or medical coding experience in hospital, surgical, or clinical settings.
Minimum 1+ years of experience in healthcare operations or BPO environment.
Experience in CPT and ICD coding standards or ability to obtain AAPC CPC certification.
Strong knowledge of PC-based software and healthcare systems.
Demonstrated analytical thinking, critical reasoning, and problem-solving abilities.
Preferred Qualifications
Background in Allied Medical Health disciplines such as Registered Nurse, Physiotherapist, Radiologic Technologist, or Pharmacist.
Experience in health insurance billing and medical coding processes.
Ability to manage multiple priorities and meet performance targets.
Strong teamwork and collaboration skills.
Excellent verbal and written communication and presentation skills.
Work Environment and Schedule
Full-time position based in Hyderabad, India.
Flexible shift schedule based on business requirements.
No travel required.
Role may involve changes in work assignments, shifts, or team structure based on operational needs.
About the Organization
Optum, a part of UnitedHealth Group, is a global healthcare organization that leverages technology, data, and clinical expertise to help people live healthier lives. The organization focuses on improving healthcare delivery by connecting patients with care services, pharmacy benefits, and health resources while promoting innovation, inclusion, and professional growth.
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