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    Subject Matter Expert

    Optum
    2+ years
    Not Disclosed
    Noida
    10 Dec. 20, 2024
    Job Description
    Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

    Job Title: Medical Coder - ICD-10 Specialist (Remote Potential)
    Location: [Insert Location]

    About Optum:
    Optum is a global healthcare organization that uses technology to provide care, helping millions of people live healthier lives. Joining our team will allow you to directly impact health outcomes by connecting people with essential resources, care, and pharmacy benefits. We foster a culture of diversity and inclusion, offer talented peers to collaborate with, and provide opportunities for career development. At Optum, we work together to advance health equity on a global scale. Come make a difference in the communities we serve while growing with us.

    Primary Responsibilities:

    • Review, analyze, and interpret electronic medical records for current admissions to identify all diagnoses and procedures documented.
    • Assign the principal and secondary ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes, following official coding guidelines and your knowledge of anatomy, physiology, and pathophysiology.
    • Identify cases that may require documentation clarification or specificity to assign codes accurately; collaborate with the Clinical Documentation Integrity (CDIS) team for clarification.
    • Ensure accurate code assignment and sequencing in compliance with ICD-10 Official Coding Guidelines, UHDDS, and other regulatory requirements.
    • Analyze medical record documentation for accurate severity of illness and risk of mortality scores.
    • Confirm Admission-Discharge-Transfer (ADT) information and make corrections when necessary.
    • Assist in workflow process improvements and participate in coding quality and productivity reviews.
    • Identify training needs and refer to the Supervisor/Manager.
    • Stay updated on annual ICD-10 coding system changes and regulations, providing expert coding advice to colleagues.
    • Comply with employment contract terms, company policies, and directives regarding work location, team changes, or work shifts.

    Required Qualifications:

    • Education: Graduate or Postgraduate in Life Sciences, Allied Medicine (BHMS, BAMS, BPT, Dental Grads, Pharmacist, Nursing).
    • Certification: Certified coder – AAPC / AHIMA – CCS/CPC/CPC-H/CCS-P.
    • In-depth knowledge of medical terminology, human anatomy/physiology, pathophysiology, pharmacology, and ancillary test results.
    • Expertise in complex medical coding concepts encountered in an Academic Medical Center.
    • Familiarity with current ICD-10-CM/PCS coding systems and conventions, including Official Coding Guidelines.
    • Knowledge of external auditing programs like Recovery Audit Contractors (RAC), OIG, and third-party payors.
    • Understanding of medications and dosages.
    • Strong English communication skills.
    • Proficiency in Microsoft Office (Outlook, Word, Excel).
    • Experience interpreting and assessing provider documentation.
    • Critical thinking skills with the ability to analyze, assess, and evaluate situations and documentation.
    • Strong analytical skills and the ability to work independently with minimal supervision.
    • Ability to prioritize tasks and provide feedback based on error trends.
    • Willingness to work flexible hours, including weekends, as needed.

    Remote Opportunity:
    This position offers the potential to work remotely.

    About UnitedHealth Group:
    At UnitedHealth Group, our mission is to help people live healthier lives and make healthcare better for everyone. We believe that everyone, regardless of race, gender, sexuality, age, location, or income, deserves the opportunity to live their healthiest life. We are committed to eliminating barriers to good health, particularly for marginalized communities, and delivering equitable care that improves health outcomes for all.

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