Subject Matter Expert - IPDRG

Optum India; Chennai; On-site; INR 900,000 - 1,500,000; Full time

Job summary

Optum India is seeking a senior IP-DRG Coder to audit coded medical records using ICD-10 and CPT, ensuring HIPAA compliance and high-quality output. You will identify discrepancies, query responsible parties, and mentor junior coders while meeting productivity targets.

The role requires 6+ years of IP-DRG coding, strong knowledge of ICD-10-CM/PCS, effective communication in English, and experience leading calibration sessions between SMEs, auditors and trainers.

Qualifications

• Graduate or Postgraduate degree required.
• Certified coder with AAPC/AHIMA CCS/CPC/CPC or CIC (any one).
• 6+ years of hands-on IP DRG coding experience.
• Solid knowledge of IP-DRG methodology, ICD-10-CM/PCS guidelines, Coding Clinic guidance, and US Healthcare RCM systems.
• Thorough knowledge of medical terminology, anatomy/physiology, pathophysiology.
• Understanding of medications and dosages.
• Strong English communication skills.
• Proven ability to provide proper feedback on errors and conduct training based on error trends.
• Proven ability to lead calibrations between SMEs, auditors and trainer group.

Responsibilities

• Auditing coded medical records using ICD-10 and CPT.
• Adhering to HIPAA regulations.
• Identify inconsistencies and discrepancies in medical data and query the responsible party, coder and supervisor as needed.
• Meet auditor quality and productivity standards and deadlines.
• Educate coders through feedback on errors.
• Analyze, report and conduct sessions on error trends.
• Lead calibration calls between SMEs, auditors and trainers.
• Report malpractices noticed during auditing of any coder.
• Educate coders on coding updates.
• Demarcate between educational feedback and errors; review rebuttals with integrity.
• Comply with all company policies and work arrangement changes.

Skills

IP-DRG coding

English communication

Auditing & training

HIPAA compliance

Education

Graduate or Postgraduate

Job description

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.