Hyderabad Telangana Us healthcare process claim processing Jobs – 31 Open Jobs Today

Clinical Investigator
Optum —Hyderabad, Telangana
- Full-time
- B.Sc
- Analysis skills
- Bachelor's degree
- Health insurance
Senior Executive - Payment Posting (US Healthcare)
Gulf Coast RCM and Billing Solutions —Hyderabad, Telangana
- ₹30,000 - ₹40,000 a month
- Full-time
- Microsoft Excel
- Analysis skills
- In-person
- Commuter assistance
- Health insurance
Quick apply
Process Trainee Consultant- (US Healthcare)- Hyderabad
Global Digi Recruit —Hyderabad, Telangana
- ₹15,000 - ₹28,000 a month
- Full-time
- Customer service
- English
- 12th Pass
- Commuter assistance
- Health insurance
Quick apply
Advisory Consultant - Actuarial, Medicare, Analytics
Optum —Hyderabad, Telangana
- Full-time
- SQL
- Presentation skills
- Bachelor's degree
- Health insurance
Medical Biller – US Healthcare
Harmony United Psychiatric Care —Hyderabad, Telangana
- Email
- HIPAA
- Bachelor's degree
- Organizational skills
- Health insurance
Quick apply
Salesforce Manager
Zelis —Hyderabad, Telangana
- Full-time
- Hybrid work
- Management
- Computer Science
- Salesforce
QA & Testing Lead Analyst- HIH - Evernorth
The Cigna Group —Hyderabad District, Telangana
- Full-time
- Oracle
- Databases
- SQL
RCM AR Analyst
ModMed Technologies India Private Limited —Cyberabad, Hyderabad, Telangana
- Analysis skills
- Bachelor's degree
- Communication skills
- Paid holidays
- Paid sick time
Quick apply
Director, RCM AR Operations
ModMed Technologies India Private Limited —Cyberabad, Hyderabad, Telangana
- Full-time
- Microsoft Excel
- Master's degree
- Project management
- Paid holidays
- Paid sick time
Quick apply
TPA Executive Hyderabad
Watchyourhealth.com India Private Limited —Begumpet, Hyderabad, Telangana
- ₹23,000 - ₹25,000 a month
- Full-time
- English
- In-person
- Medical terminology
Quick apply
14d
Senior Executive – Audit Operations
Sagility —Hyderabad
Customer Service Representative
The U.S. Pharmacopeia (USP) —Hyderabad, Telangana
- Full-time
- Microsoft Word
- Spanish
- Microsoft Excel
- Paid time off
- Flexible schedule
AR Group Coordinator
Elico —Hyderabad, Telangana
- ₹38,000 - ₹41,000 a month
- Email
- Microsoft Word
- Microsoft Excel
- HIPAA
- Health insurance
Quick apply
Team Lead - Trade Finance (Promotions & Claim) - Consumer Health NRT
Dr Reddy's Laboratories Limited —Hyderabad, Telangana
- Full-time
- Microsoft Excel
- Master's degree
- MBA
- Health insurance
Quick apply
Senior QA Lead
Persistent —Hyderabad, Telangana
- Full-time
- Hybrid work
- SQL
- Communication skills
- Python
- Flexible schedule
7d
HIH - Application Development Lead Analyst
The Cigna Group —Hyderabad District, Telangana
- Full-time
- Oracle
- Software troubleshooting
- SQL
RCM Coding Specialist
ModMed Technologies India Private Limited —Cyberabad, Hyderabad, Telangana
- Full-time
- Microsoft Excel
- B.Sc
- English
- Paid holidays
- Paid sick time
Quick apply
Associate Software Developer
Lumiknox —Hyderabad, Telangana
- ₹2,66,953.10 - ₹5,83,506.98 a year
- Full-time
- Remote
- Azure
- Computer Science
- English
- Health insurance
- Paid time off
Quick apply
5d
Medical Coding : IP-DRG
R1 RCM, Inc. —Hyderabad, Telangana
- Full-time
- Anatomy knowledge
- Bachelor's degree
- Medical terminology
Medical Biller – Accounts
Harmony United Psychiatric Care —Hyderabad, Telangana
- Full-time
- HIPAA
- Bachelor's degree
- Time management
- Commuter assistance
- Health insurance
Quick apply

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Clinical Investigator

Optum -
Hyderabad, Telangana

Apply Now

Job details

Full-time

Benefits

Health insurance

Qualifications

B.Sc
BUMS
Analysis skills
Science
Medical records
Bachelor's degree
CPT coding
BAMS
Nursing
MPT

Full job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

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

Fraud is intentionally misrepresenting or concealing facts to obtain something of value. The complete definition has three primary components:

Intentional dishonest action or misrepresentation of fact
Committed by a person or entity
With knowledge that dishonest action or misrepresentation could result in an inappropriate gain or benefit

This definition applies to all persons and all entities. However, there are special rules around intentional misrepresentations to Government programs such as Medicare and Medicaid, or TRICARE.

Waste includes inaccurate payments for services, such as unintentional duplicate payments, and can include inappropriate utilization and/or inefficient use of resources.

Abuse includes any practice that results in the provision of services that:

Are not medically necessary
Do not meet professionally recognized standards for health care
Are not fairly priced

Primary Responsibilities:

Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise, knowledge of CPT or diagnosis codes, CMS guideline along with referring to client specific guidelines and member policies
Adherence to state and federal compliance policies and contract compliance
Assist the prospective team with special projects and reporting
Coordinate with all team members and share recent process related updates
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

Medical degree - BHMS/BAMS/BUMS/BPT/MPT
B.Sc Nursing and BDS with 1+ years of corporate experience
6+ months of experience (Fresher's in BPT / MPT / BHMS/ BAMS/ BUMS can also apply)
CPC Certification Mandate.
Extensive work experience within own function
Proven attention to detail & quality focused
Proven good analytical & comprehension skills
Proven ability to work independently

Preferred Qualifications:

Claims processing experience
Health Insurance knowledge, managed care experience
Knowledge of US Healthcare and coding
Medical record familiarity

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Apply Now

Refine Your Search

us healthcare process claim processing jobs in hyderabad telangana

Clinical Investigator

Senior Executive - Payment Posting (US Healthcare)

Process Trainee Consultant- (US Healthcare)- Hyderabad

Advisory Consultant - Actuarial, Medicare, Analytics

Medical Biller – US Healthcare

Salesforce Manager

QA & Testing Lead Analyst- HIH - Evernorth

RCM AR Analyst

Director, RCM AR Operations

TPA Executive Hyderabad

Senior Executive – Audit Operations

Customer Service Representative

AR Group Coordinator

Team Lead - Trade Finance (Promotions & Claim) - Consumer Health NRT

Senior QA Lead

HIH - Application Development Lead Analyst

RCM Coding Specialist

Associate Software Developer

Medical Coding : IP-DRG

Medical Biller – Accounts

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