Optum, Inc.

Arun Kumar Tiwari

Mohit Singhal

Urvi Sharma

Amardeep Sharma

Systems and methods for targeted medical document review are disclosed. A list of medical documents is received. Each medical document is associated with a user enrolled in a plan subject to a medical document review process. A dataset for each medical document, including clinical data, membership data, and provider data associated with the user, is received. A first model is used to determine whether each medical document includes an undocumented condition based on the dataset. The list is reduced to a subset of medical documents determined to include an undocumented condition. A second model is used to determine a risk score associated with each medical document of the subset based on the dataset. The subset of medical documents are ordered in the reduced list based on the risk scores. The ordered, reduced list is provided as input to the medical document review process.

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New Delhi, India

Arun Kumar Tiwari