Subject Matter Expert - IPDRG

Optum India; Chennai District; On-site; INR 600,000 - 1,200,000; Full time

Job summary

Optum India is seeking a medical coding auditor to review ICD-10/CPT records, ensure HIPAA compliance and provide precise feedback for coding accuracy.

You will collaborate with SMEs, auditors and trainers, lead calibration sessions and mentor coders while maintaining data integrity and meeting deadlines in a dynamic health-care environment.

Qualifications

• Graduate or postgraduate in Life Sciences or Allied Medicine.
• Certified coder: AAPC/AHIMA CCS/CPC/CPC-H/CCS-P.
• 5+ years of coding experience in IPDRG.
• Strong knowledge of medical terminology and anatomy.
• Proficient English communication.
• Ability to provide training based on error trends and feedback.
• Experience leading calibrations among SMEs, auditors and trainers.

Responsibilities

• Audit coded medical records using ICD-10 and CPT.
• Adhere to HIPAA regulations.
• Identify and report inconsistencies or inaccuracies in medical data.
• Meet quality and productivity standards and deadlines.
• Educate coders through feedback on errors.
• Analyze error trends and conduct sessions on findings.
• Lead calibration calls between SMEs, auditors and trainers.
• Report malpractices noticed during auditing.
• Educate coders on coding updates.
• Distinguish educational feedback from errors and maintain integrity in reviews.
• Comply with employment contracts, policies and directives.

Skills

Medical coding

English communication

HIPAA knowledge

Quality feedback

Training leadership

Education

Graduate in Life Sciences

Postgraduate in Allied Medicine

Tools

AAPC/AHIMA certifications

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.

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 the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications

• 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
• 5+ years of coding experience in relevant specialty IPDRG
• Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
• Understanding of interpreting the medications and dosages
• Proven good in English communication
• Demonstrated ability to provide proper and detailed feedback on errors and conduct/provide training based on error trends
• Demonstrated ability to participate/conduct/lead calibrations between SMEs, auditors and trainer group

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.