Subject Matter Expert (SME) – ED & E/M Coding
Requisition Number: 2305985
Job Category: Medical & Clinical Operations
Location: Hyderabad, Telangana, IN
About the Role
We are seeking experienced and detail-oriented Subject Matter Experts (SMEs) specializing in Emergency Department (ED) and Evaluation & Management (E/M) Outpatient/Inpatient (OP/IP) coding. The SME will ensure coding accuracy, regulatory compliance, and support training, audits, and process improvement initiatives. This role is critical in maintaining high-quality coding standards and supporting continuous improvement.
Key Responsibilities
Coding & Compliance
Perform high-level coding reviews for ED and E/M OP/IP encounters.
Ensure accurate assignment of CPT, ICD-10-CM, and HCPCS codes based on documentation.
Validate code selection against payer-specific guidelines and NCCI edits.
Identify coding trends and provide feedback to improve accuracy and documentation quality.
Participate in internal and external coding audits.
Collaborate with compliance teams to address audit findings and implement corrective actions.
Stay updated on regulatory changes (CMS, AMA, etc.) and align coding practices with current standards.
Training, Support & Process Improvement
Provide SME input for system enhancements, coding tools, and automation initiatives.
Support client queries and escalations related to ED and E/M coding.
Work with cross-functional teams to streamline coding workflows.
Administrative & Compliance Responsibilities
Comply with employment contracts, company policies, and directives including transfers, reassignments, work shifts, and alternative work arrangements.
Maintain adherence to company procedures in a dynamic business environment.
Required Qualifications
Certification: CPC, CCS, or equivalent.
Experience:
5+ years in medical coding with specialization in ED and/or E/M OP/IP coding
Experience with coding platforms and EMR systems (e.g., Epic, Cerner)
Knowledge & Skills:
Solid understanding of CPT, ICD-10-CM, HCPCS, CMS, and AMA guidelines
Excellent communication, analytical, and problem-solving skills
Why Join UnitedHealth Group / Optum
Work with a global organization committed to improving health outcomes through technology and innovation.
Join a culture that values inclusion, collaboration, and professional development.
Contribute to initiatives addressing health disparities, equity, and sustainability.
Make a meaningful impact on patients, communities, and the healthcare system.
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