Medical Coding

Position Title: Clinical Investigator Analyst

Locations: Chennai / Hyderabad / Noida

Work Arrangement: On-site at Global Capability Center (GCC)

Shift Schedule: Standard Day Shift

Role Overview

We are looking for highly proficient Clinical Investigator Analysts to become part of our Global Capability Center (GCC) located in Chennai. This position presents an excellent opportunity for experienced medical coding specialists to pivot into a focused Medical Coding and Clinical Investigation role, with substantial potential for career advancement within the healthcare industry.

The successful candidate should demonstrate comprehensive expertise in Medical Coding, Clinical Documentation Review, and Clinical Investigation. A solid understanding of Anatomy, Physiology, Pathology, Anesthesia, Evaluation & Management (E/M), Emergency Department (ED), Surgery, and Surgical Coding is essential.

Selected candidates will undergo a 3-month structured domain training program designed to develop skills in clinical investigation techniques, payment integrity, fraud, waste & abuse (FWA) detection, and adherence to client-specific policies. This training prepares analysts to conduct high-quality clinical investigations in a global healthcare setting.

The role entails reviewing complex medical claims and clinical documentation to detect and prevent fraudulent, abusive, or inaccurate claims. This is achieved through applying medical expertise, CPT/ICD coding standards, CMS guidelines, client policies, and regulatory compliance.

This opportunity is ideal for professionals aiming to transition from traditional medical coding to roles involving advanced clinical analytics, investigations, and healthcare compliance.

Why Choose Us

• Opportunity to contribute to a Global Capability Center (GCC) serving international healthcare clients.
• Transition from conventional medical coding to a specialized Medical Coding & Clinical Investigation career pathway.
• 3 months of intensive training to develop expertise in clinical investigations and payment integrity.
• Gain exposure to global healthcare standards, advanced investigation practices, and complex clinical case assessments.
• Strong career progression options into Medical Coding, Clinical Investigation, Clinical Auditing, Healthcare Analytics, Fraud Detection, and Medical Review domains.
• Ongoing learning, mentorship, and growth opportunities within a dynamic healthcare operations environment.

Main Responsibilities

Medical Coding & Clinical Validation

• Assess and validate CPT, ICD-10-CM, HCPCS, and diagnosis codes for accuracy and compliance.
• Review medical records to ensure proper code selection and clinical documentation integrity.
• Validate coding related to Evaluation & Management (E/M), Emergency Department (ED), Surgical procedures, Anesthesia, and other specialties.
• Identify discrepancies such as upcoding, downcoding, documentation gaps, and billing errors.
• Recommend corrective actions aligned with coding standards and payer policies.

Clinical Specialties Expertise

Strong clinical knowledge in one or more of the following areas:

Anatomy

Pathology

Evaluation & Management (E/M)

Surgery

Inpatient & Outpatient Coding

Physiology

Anesthesia

Emergency Department (ED)

Surgical Coding

Medical Necessity Review

Compliance & Regulatory Adherence

• Ensure compliance with:

CMS (Centers for Medicare & Medicaid Services) Guidelines

ICD-10-CM Coding Standards

National Correct Coding Initiative (NCCI)

State and Federal Healthcare Regulations

CPT Coding Guidelines & Contract Compliance

HCPCS Coding Standards

Client-specific Medical Policies

HIPAA Regulations

• Maintain confidentiality and safeguard sensitive healthcare data.

Clinical Investigation Responsibilities

• Examine complex medical claims and supporting clinical documentation to identify potential fraud, waste, abuse, billing inaccuracies, and coding issues.
• Utilize clinical expertise to assess medical necessity, coding precision, and reimbursement appropriateness of healthcare services.
• Prevent improper claim payments through detailed clinical investigations and evidence-based analysis.
• Compare provider documentation against coding guidelines, medical policies, CMS standards, and payer-specific requirements.
• Draft clear, comprehensive investigation summaries with supporting clinical rationale.

Quality & Continuous Improvement

• Maintain high standards of coding accuracy, productivity, and investigative quality.
• Participate in quality audits, calibration exercises, and peer reviews.
• Identify patterns of inappropriate billing and coding errors, contributing to process improvements.
• Support operational excellence initiatives and continuous process enhancements.

Collaborative Engagement

• Work closely with Clinical Investigators, Medical Directors, Payment Integrity Teams, Quality Assurance, Coding Auditors, and Operations personnel.
• Share knowledge and participate in clinical discussions and case reviews.
• Engage in policy interpretation, case discussions, and appeals processes.

Training & Career Growth Opportunities

• Participate in a detailed 3-month structured training program covering:

Clinical Investigation

Fraud, Waste & Abuse (FWA) Detection

Medical Policy Interpretation

Investigation Techniques

Payment Integrity Strategies

Clinical Analytics

Client-specific Guidelines

Global Healthcare Processes

Opportunity to evolve from core medical coding roles into specialized clinical investigation and payment integrity functions.

Excellent prospects for long-term career development within a Global Capability Center supporting international healthcare operations.

Essential Skills & Qualifications

Medical Coding Expertise

• CPC Certification (mandatory)
• Proficiency in ICD-10-CM coding standards
• Experience in Medical Record Review
• Knowledge of Coding Validation Processes
• Familiarity with CPT Coding
• Understanding of HCPCS Coding
• Experience with Clinical Documentation Improvement (CDI)
• Conducting Coding Audits

Clinical Knowledge Base

• Strong understanding of:

Anatomy

Pathology

Pharmacology & Medical Terminology

Anesthesia

Emergency Department (ED)

Physiology

Disease Processes

Surgical Procedures

Evaluation & Management (E/M)

Surgical Coding

Candidate Eligibility Criteria

• Mandatory CPC Certification.
• Robust knowledge of medical coding principles and clinical documentation practices.
• Expertise in Anatomy, Physiology, Pathology, Anesthesia, E/M, Emergency Department (ED), Surgery, and Surgical Coding.
• Willingness to work in a Global Capability Center (GCC) environment with rotational/US shift timings.