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Clinical Investigator

3.00 to 4.00 Years   Noida   08 Jul, 2019
United Health Group
Job LocationNoida
EducationNot Mentioned
SalaryNot Disclosed
IndustryMedical / Healthcare
Functional AreaMedical TranscriptionPharmacist / Medical Representative
EmploymentTypeFull-time

Job Description

Position Description This process works on identifying discrepancies between medical records and billed services for complex and high value claims by identifying Up-coding, Unbundling, Duplication, and Misrepresentation of services. They approve/deny claims & Identify provider aberrant behavior patterns. The associates prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies.Primary Responsibilities:

  • Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT/diagnosis codes, CMC guideline along with referring to client specific guidelines and member policies
  • Adhere to state and federal compliance policies and contract compliance
  • Assist the prospective team with special projects and reporting
Required Qualifications:
  • Medical degree - BHMS/BAMS/BUMS/BPT/MPT/Graduate in Nursing
  • 0-4 years of over-all experience (Freshers can apply)
  • Attention to detail and Quality focused
  • Good Analytical and comprehension skills
Preferred Qualifications:
  • Claims Processing experience
  • Health Insurance knowledge, Managed Care experience
  • Knowledge of US Healthcare and Coding
  • Medical Record familiarity
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Keyskills :
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