Quality Analyst- IPDRG

Optum; Dadri, Hyderabad, Chennai District; On-site; INR 700,000 - 1,100,000; Full time

Job summary

Optum is seeking Quality Auditors for IPDRG Coding in multiple India locations. Roles involve auditing coded records, ensuring HIPAA compliance, and leading calibration between SMEs, auditors and trainers.

The ideal candidate has 6+ years of coding experience in relevant specialties, strong knowledge of ICD-10/CPT and AAPC/AHIMA certifications, and excellent English communication skills.

Qualifications

• Graduate or postgraduate in Life Sciences or Allied Medicine.
• Certified coder with AAPC or AHIMA – CCS/CPC/CPC-H/CCS-P.
• Strong English communication.
• Thorough knowledge of medical terminology, human anatomy/ physiology.
• Minimum of 6 years coding experience in relevant specialty.
• Ability to provide proper feedback on errors and conduct training based on error trends.
• Ability to participate in lead calibrations between SMEs, auditors and trainer group.

Responsibilities

• Auditing coded medical records using ICD-10 and CPT.
• Know and adhere to HIPAA regulations.
• Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party, coder and supervisor.
• Meet auditor quality and productivity standards and deadlines/turnaround times set up for the process.
• Educate coders through feedback on errors.
• Analyze, report and conduct sessions on error trend observed.
• Conduct/participate/lead calibration calls between SMEs, auditors and trainers.
• Report malpractices noticed during auditing of any coder.
• Educate coders on coding updates.
• Carefully demarcates between educational feedback and errors.
• Reviews rebuttals with integrity.

Skills

Medical terminology

ICD-10/CPT coding

English communication

Auditing experience

Training/feedback

Calibration leadership

Education

Life Sciences

Allied Medicine

BHMS

BAMS

BPT

Dental

Pharmacist

Nursing

Tools

AAPC Certification

AHIMA Certification

HIPAA compliance knowledge

Job description

Greeting From Optum!!

Optum is hiring Quality Auditors for IPDRG Coding in Hyderabad ,Chennai & Noida

Medical Coding QA - IPDRG

Requirements

• Education Background:
• Graduate or Postgraduate in: Life Sciences, Allied Medicine (BHMS, BAMS, BPT, Dental Grads, Pharmacist, Nursing)
• Certification:
• Should be a certified coder AAPC / AHIMA – CCS/CPC/CPC-H/CCS-P
• Good in English communication
• Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
• Should have understanding of interpreting the medications and dosages.
• Should have minimum of 6 yrs. coding experience in relevant specialty.
• Should be able to provide proper and detailed feedback on errors and conduct/provide training based on error trends.
• Should be able to participate/conduct/lead calibrations between SMEs, auditors and trainer group.

Roles and Responsibilities post training

• Auditing coded medical records using the ICD-10 and CPT.
• Know and adhere to HIPAA regulations.
• Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party, coder and supervisor.
• Meet auditor quality and productivity standards and deadlines/turnaround times set up for the process.
• Educate coders through feedback on errors.
• Analyze, report and conduct sessions on error trend observed.
• Conduct/participate/lead calibration calls between SMEs, auditors and trainers.
• Report malpractices noticed during auditing of any coder.
• Educate coders on coding updates.
• Carefully demarcates between educational feedback and errors.
• Reviews rebuttals with integrity.