Senior Clinical Administrative Coordinator - Medical Coding

Roles & Responsibilities
• Review prepay claims with corresponding medical records to determine payment accuracy
• Evaluate applicable policies, CPT guidelines, and contracts related to clinical review
• Investigate and resolve instances of healthcare fraud and abuse
• Provide coding guidance to investigators on CPT codes relevant to investigations
• Document findings using information from tips, member benefits, and medical records
• Participate in regulatory meetings with clients and discussions with providers, advocates, and legal teams
• Monitor claim inventory to ensure adherence to performance guarantees and targets
• Assist in internal and external projects, analyze data, and collaborate with stakeholders for resolution
• Mentor junior staff and provide guidance on complex coding and investigation issues
• Maintain compliance with company policies, employment terms, and regulatory requirements

Qualification
• Graduate of minimum 4-year course in Allied Medical Health
• Certified Professional Coder (CPC)
• CPT & ICD coding experience or must pass AAPC CPC Certification provided by the organization

Experience
• 1+ year clinical or coding experience (surgical, hospital, or clinic settings)
• 1+ year BPO experience
• Experience in health insurance billing/coding preferred

Skills
• Strong knowledge of CPT and ICD coding guidelines
• Critical thinking, analytical, and problem-solving skills
• Proficiency in PC-based software
• Ability to manage multiple tasks and prioritize effectively
• Strong oral and written communication skills
• Ability to work collaboratively in a team environment

About The Company
Optum, part of UnitedHealth Group, is a global healthcare organization delivering technology-enabled health services, pharmacy benefits, and data-driven solutions. The company focuses on improving health outcomes, advancing equitable care, and transforming healthcare systems worldwide through innovation, compliance excellence, and operational expertise.