Join Optum, a global leader dedicated to improving health outcomes through innovative technology and compassionate care. We connect individuals with the essential resources they need to thrive. Our inclusive culture fosters collaboration with talented professionals, offering comprehensive benefits and robust career development. Be part of a team that advances health optimization worldwide, embodying our commitment to Caring, Connecting, and Growing together.

This role is crucial in safeguarding against fraudulent claims by leveraging medical expertise and detailed knowledge of coding systems and client-specific guidelines. Contribute to a compliant and efficient claims processing environment.

Apply medical expertise to prevent the payment of potentially fraudulent or abusive claims, utilizing knowledge of CPT/diagnosis codes, CMS guidelines, and client-specific policies.

Ensure adherence to all state and federal compliance regulations and contract requirements.

Support the team with special projects and reporting, contributing to data analysis and process improvement initiatives.

Collaborate effectively with team members, sharing updates on processes and best practices.

Maintain compliance with all company policies, procedures, and business directives, including those related to work location, team assignments, and schedules.

Must possess a Graduation degree. Preferred degrees include BHMS, BAMS, BUMS, BPT, MPT, B.Sc. Nursing, or BDS.

Requires 1+ years of corporate experience for B.Sc. Nursing and BDS graduates. For other medical graduates, 1+ years of experience in specialty coding (e.g., E&M, surgery, anesthesia) is needed, excluding solely HCC.

Certified coders through AAPCC (CPC certification only) are highly desired.

Demonstrated expertise in attention to detail, quality assurance, and strong analytical and comprehension skills is essential.

Familiarity with claims processing, health insurance, managed care, and US healthcare coding practices, along with medical record review, is advantageous.