Quality Auditor – ED
Company: Optum (UnitedHealth Group)
Job Title: Quality Auditor – ED
Location: Noida, Uttar Pradesh (Additional location: Chennai)
Job Category: Medical & Clinical Operations
Experience Required: 5+ Years
Employment Type: Full-time
Job Summary
Optum is hiring a Quality Auditor – ED responsible for auditing emergency department coding quality, ensuring compliance with healthcare regulations, improving documentation accuracy, and supporting coding teams through feedback, training, and quality improvement initiatives.
Key Responsibilities
Conduct coding quality audits for Emergency Department (ED) professional and facility coding.
Review coding accuracy, documentation quality, and compliance with coding standards.
Provide detailed feedback, education, and guidance to coders, billers, and clinical teams.
Support coders in resolving complex coding cases and documentation clarification.
Coordinate Corrective Action Plans (CAPs) and ensure implementation.
Identify coding gaps, performance trends, and quality improvement opportunities.
Assist in developing and refining:
Audit frameworks
Compliance policies
Workflows
Internal controls
Monitor coding performance through audits, assessments, and quality reviews.
Analyze data to detect:
Outliers
High-risk coding patterns
Billing irregularities
Fraud, Waste & Abuse (FWA)
Stay updated with coding guideline changes from:
CMS
AMA
AHA Coding Clinics
Collaborate with compliance, QA, operations, physician practices, and coding education teams.
Support documentation improvement initiatives and coding clarification requests.
Participate as a compliance subject matter expert in departmental discussions.
Required Qualifications
Mandatory AAPC / AHIMA Certification
Accepted certifications:
CPC
CIC
CCS
COC
CPMA
5+ years of hands-on Emergency Department auditing experience
Professional Fee (Profee)
Facility Coding
Preferred Qualification
Bachelor’s degree in Health Information Management, Life Sciences, or related field
Required Skills
Technical Skills
Emergency Department (ED) Coding Auditing
Professional Fee (Profee) Auditing
Facility Coding Auditing
US Healthcare Revenue Cycle Management (RCM)
2021 E&M Guidelines
CMS Documentation Standards
Medical Coding Compliance
Fraud, Waste & Abuse (FWA) Monitoring
Clinical Documentation Review
Quality Assurance Auditing
Tools & Systems
EPIC
eCAC
3M
Cerner
EMR / EHR Platforms
Auditing Tools
Soft Skills
Excellent attention to detail
Strong analytical thinking
Communication skills
Documentation review expertise
Problem-solving ability
Team collaboration
Quality improvement mindset
Uttar Pradesh :
Agra | Gajraula | Gautam buddha Nagar | Ghaziabad | Gorakhpur | Greater Noida | Jhansi | kanpur | Lucknow | Mathura | Noida | Park City | Prayagraj | Satyamev | Varanasi |Gujarat :
Ahmedabad | Ankleshwar | Baroda | Bharuch | Gandhinagar | Gujarat | Halol | Jhagadia | Mehsana | surat | Tarasadi | Vadodara | Vapi |Maharashtra :
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amritsar | Bathinda | Bela | Chandigarh | ludhiana | Moga | Mohali | Patiala | Phagwara | Punjab | Rajpura |Andra Pradesh :
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Rangpo |India :
Remote, India | Siliguri |Illinois :
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Norway | NOrway |Romania :
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Netherlands |Remote Australia :
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Canada |Quebec :
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Brussels |Antwerp :
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Greece |North Island :
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Manila |Croatia :
Croatia |Zagreb :
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