Subject Matter Expert (ED) – Optum
Job Overview
Job Title: Subject Matter Expert (ED)
Company: Optum
Location: Hyderabad, Telangana, India
Job Category: Medical & Clinical Operations
Requisition Number: 2363805
Date Posted: 11 May 2026
Travel Requirement: No
Employment Type: Full-time
About the Company
Optum, a part of UnitedHealth Group, is a global healthcare organization focused on improving health outcomes through technology, pharmacy benefits, healthcare services, and data-driven solutions. The company emphasizes innovation, inclusion, integrity, compassion, and performance.
Key Responsibilities
Medical Coding Audit & Quality Assurance
Audit coded medical records using ICD-10 and CPT coding standards
Review coding accuracy and compliance with quality benchmarks
Ensure productivity targets and turnaround times are consistently met
Data Review & Error Identification
Identify inconsistencies, discrepancies, and inaccuracies in medical records
Interpret and evaluate medical documentation for correctness
Escalate coding/documentation issues to coders, supervisors, or relevant stakeholders
Training & Feedback Management
Provide detailed educational feedback to coders regarding coding errors
Conduct training sessions based on observed coding error trends
Educate coders on coding guideline updates and best practices
Differentiate between educational observations and actual coding errors
Audit Reporting & Analysis
Analyze recurring coding errors and prepare reports
Track quality trends and recommend process improvements
Review rebuttals submitted by coders with fairness and integrity
Collaboration & Leadership
Participate in and lead calibration calls with:
SMEs
Auditors
Trainers
Support knowledge-sharing and process alignment across teams
Compliance & Governance
Ensure adherence to HIPAA regulations
Report any malpractice or compliance violations identified during audits
Follow company employment policies, reassignment directives, and business requirements
Required Qualifications
Educational Qualification
Candidates must hold a Graduate or Postgraduate degree in one of the following:
Life Sciences
Allied Medicine
BHMS
BAMS
BPT
Dental Sciences
Pharmacy
Nursing
Certification Requirements
Candidates must have at least one valid medical coding certification:
AAPC Certification
CPC
CPC-H
OR
AHIMA Certification
CCS
CCS-P
Experience Required
6+ years of medical coding experience
Experience in relevant specialty coding (ED / Emergency Department preferred)
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