Subject Matter Expert - IPDRG

Optum; Chennai; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

UnitedHealth Group is seeking a Subject Matter Expert for IPDRG in Chennai to audit, educate and calibrate coding professionals, ensuring high accuracy in IP-DRG coding and adherence to HIPAA and related regulations.

The role requires certified coding credentials and 6+ years of IP-DRG experience, with strong English communication and the ability to lead training and inter-team calibrations. This position is based in India with a focus on improving data quality and healthcare outcomes.

Qualifications

• Graduate or postgraduate education in a relevant field.
• Certified coder via AAPC/AHIMA CCS/CPC/CPC or CIC.
• 6+ years hands-on IP DRG coding.
• Strong knowledge of IP-DRG methodology, ICD-10-CM/PCS guidelines and Coding Clinic guidance.
• Excellent English communication; ability to provide feedback and lead training.
• Experience coordinating calibrations among SMEs, auditors and trainers.

Responsibilities

• Audit coded medical records using ICD-10 and CPT.
• Adhere to HIPAA regulations.
• Identify inconsistencies in medical data and raise queries.
• Meet quality and productivity standards and deadlines.
• Educate coders through feedback on errors.
• Conduct calibration calls between SMEs, auditors and trainers.
• Report malpractices noticed during auditing.
• Educate coders on coding updates.
• Review rebuttals with integrity.
• Ensure compliance with company policies and flexible work arrangements.

Skills

English communication

Training feedback

Calibrations coordination

Education

Graduate or Postgraduate

Certified coder (AAPC/AHIMA CCS/CPC/CPC or CIC)

Tools

IP-DRG methodology

ICD-10-CM/PCS

US Healthcare RCM systems

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Subject Matter Expert - IPDRG (2395725)

Subject Matter Expert - IPDRG - 2395725

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

• 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
• Comply with all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements

Required Qualifications:

• Graduate or Postgraduate
• Certified coder - AAPC / AHIMA - CCS/CPC/CPC or CIC any one
• 6+ years of hands‑on IP DRG Coding
• Solid knowledge of IP-DRG methodology, ICD-10-CM/PCS guidelines, Coding Clinic guidance, and US Healthcare RCM systems
• Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
• Understanding of interpreting the medications and dosages
• Proven good in English communication
• Proven ability to provide proper and detailed feedback on errors and conduct/provide training based on error trends
• Proven ability to participate/conduct/lead calibrations between SMEs, auditors and trainer group

Preferred Qualification:

• Experience with provider query processes, DRG validation, and audit methodologies

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.