Coding Quality Auditor – E/M / ED
Company: Optum (UnitedHealth Group)
Job Title: Coding Quality Auditor – E/M / ED
Location: Hyderabad, Telangana (Additional locations: Noida, Chennai)
Job Category: Medical & Clinical Operations
Experience Required: 5+ Years
Employment Type: Full-time
Job Summary
Optum is seeking an experienced Coding Quality Auditor – E/M / ED to perform medical coding audits, ensure documentation accuracy, maintain regulatory compliance, and support continuous quality improvement in coding operations. The role requires expertise in E/M inpatient, outpatient, and emergency department coding standards.
Key Responsibilities
Conduct comprehensive audits of medical records to verify coding accuracy and documentation completeness.
Ensure compliance with CPT, ICD-10, HCPCS, CMS, Medicare, Medicaid, HIPAA, and payer regulations.
Review coding trends, identify risk areas, and monitor coding quality performance.
Detect coding discrepancies such as:
Upcoding
Undercoding
Unbundling
Modifier misuse
Prepare audit reports including findings, corrective actions, and performance metrics.
Provide detailed feedback, training, and coding guidance to coders and clinical staff.
Support complex coding case resolution and documentation improvement initiatives.
Collaborate with compliance, QA, operations, and internal audit teams for continuous process improvement.
Assist in developing and updating audit procedures, compliance frameworks, and internal controls.
Identify potential fraud, waste, or abuse (FWA) related to billing practices.
Track coding performance through audits, assessments, and quality reviews.
Stay updated with coding guideline changes from CMS, AMA, AHA Coding Clinics.
Required Qualifications
Bachelor’s degree in Health Information Management, Life Sciences, or related field (preferred)
Mandatory certification:
CPC
CIC
CCS
COC
CPMA
(AAPC / AHIMA Certified)
Required Experience
Minimum 5+ years of hands-on coding audit experience
Strong experience in:
E/M Inpatient (Hospitalist) Auditing
E/M Outpatient Auditing
Emergency Department (ED) Coding Audits
Strong understanding of 2021 E/M guideline changes
Experience with US Healthcare Revenue Cycle Management (RCM)
Required Skills
Technical Skills
Medical Coding & Auditing
CPT / ICD-10 / HCPCS Coding
Medical Terminology
Anatomy & Physiology
CMS Documentation Guidelines
EMR / EHR Systems
Coding Tools:
EPIC
eCAC
3M
Cerner
Soft Skills
Strong analytical thinking
Excellent communication skills
Presentation skills
Attention to detail
Time management
Organizational skills
Problem-solving ability
Preferred Candidate Profile
Ideal candidate should have:
Strong compliance and auditing expertise
Experience in healthcare coding quality assurance
Ability to identify coding gaps and process improvement opportunities
Capability to mentor and guide coding teams
Strong understanding of regulatory healthcare standards
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