Medical Coding

Job Title: Clinical Investigator Analyst

Location: Chennai / Hyderabad/ Noida

Work Model: Work from Office (Global Capability Center - GCC)

Shift: General Shift

Job Summary

We are seeking highly skilled Clinical Investigator Analysts to join our Global Capability Center (GCC) in Chennai. This role offers an exciting opportunity for experienced medical coding professionals to transition into a specialized Medical Coding and Clinical Investigation function with significant career growth in the healthcare domain.

The ideal candidate should possess strong expertise in Medical Coding, Clinical Documentation Review, and Clinical Investigation, with excellent knowledge of Anatomy, Physiology, Pathology, Anesthesia, Evaluation & Management (E/M), Emergency Department (ED), Surgery, and Surgical Coding.

As part of the onboarding journey, selected candidates will undergo 3 months of structured domain training to gain expertise in clinical investigation methodologies, payment integrity, fraud, waste & abuse (FWA) identification, and client-specific policies, enabling them to perform high-quality clinical investigations within a global healthcare environment.

The role focuses on Medical Coding, reviewing complex medical claims and clinical documentation to prevent the fraudulent, abusive, or inaccurate claims by applying medical expertise, CPT/ICD coding knowledge, CMS guidelines, client-specific policies, and regulatory requirements.

This is an excellent opportunity for professionals looking to build a long-term career beyond traditional medical coding into high-value clinical analytics and investigation roles.

Why Join Us

• Opportunity to work in a Global Capability Center (GCC) supporting international healthcare clients.
• Transition from medical coding into a specialized Medical Coding &Clinical Investigation career path.
• 3 months of structured training to build expertise in clinical investigations and payment integrity.
• Exposure to global healthcare standards, advanced investigation methodologies, and complex clinical case reviews.
• Excellent career progression into Medical Coding, Clinical Investigation, Clinical Audit, Healthcare Analytics, Fraud Investigation, and Medical Review functions.
• Continuous learning, mentorship, and opportunities to grow within a high-impact healthcare operations environment.

Key Responsibilities

Medical Coding & Clinical Validation

• Review and validate CPT, ICD-10-CM, HCPCS, and diagnosis codes for coding accuracy.
• Analyze medical records to ensure appropriate code selection and clinical documentation integrity.
• Validate Evaluation & Management (E/M), Emergency Department (ED), Surgical, Anesthesia, and specialty coding.
• Identify coding discrepancies, documentation gaps, upcoding, downcoding, and billing inconsistencies.
• Recommend corrective actions based on established coding standards and payer policies.

Clinical Specialties

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 Review

• Ensure adherence to:

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 Complaince Requirements

HCPCS Coding Standards

Client-specific Medical Policies

HIPAA Compliance

• Maintain confidentiality and protect sensitive healthcare information.

Clinical Investigation

• Review complex medical claims and supporting clinical documentation to identify potential fraud, waste, abuse, billing inaccuracies, and coding discrepancies.
• Apply clinical expertise to determine the medical necessity, coding accuracy, and reimbursement appropriateness of healthcare services.
• Prevent inappropriate claim payments through detailed clinical investigations and evidence-based analysis.
• Evaluate provider documentation against coding guidelines, medical policies, CMS guidelines, and payer-specific requirements.
• Prepare clear and comprehensive investigation summaries with supporting clinical rationale.

Quality & Investigation Excellence

• Maintain high levels of coding accuracy, productivity, and investigation quality.
• Participate in quality audits, calibration sessions, and peer reviews.
• Identify trends related to inappropriate billing patterns and coding errors.
• Contribute to continuous process improvements and operational excellence initiatives.

Collaboration

• Partner with Clinical Investigators, Medical Directors, Payment Integrity Specialists, Quality Teams, Coding Auditors, and Operations teams.
• Support knowledge-sharing initiatives and clinical discussions.
• Participate in case reviews, appeals discussions, and policy interpretation meetings.

Training & Career Development

• Comprehensive 3-month structured training program on:

Clinical Investigation

Fraud, Waste & Abuse (FWA)

Medical Policy Interpretation

Investigation Methodologies

Payment Integrity

Clinical Analytics

Client-specific Guidelines

Global Healthcare Processes

·        Opportunity to transition from traditional medical coding into specialized clinical investigation and payment integrity roles.

• Excellent long-term career growth within a Global Capability Center supporting international healthcare operations.

Required Skills

Medical Coding

CPC Certification (Mandatory)

ICD-10-CM

Medical Record Review

Coding Validation

CPT Coding

HCPCS Coding

Clinical Documentation Improvement (CDI)

Coding Audits

Clinical Knowledge

Strong understanding of:

Anatomy

Pathology

Pharmacology & Medical Terminology

Anesthesia

Emergency Department (ED)

Physiology

Disease Processes

Surgical Procedures

Evaluation & Management (E/M)

Surgical Coding

Eligibility Criteria

Mandatory

• Certified Professional Coder (CPC) Certification.
• Strong knowledge of medical coding principles and clinical documentation.
• 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 and rotational/US shifts.