Subject Matter Expert – Medical Coding
Requisition Number: 2337875
Location: Hyderabad, Telangana, India
Function: Medical & Clinical Operations
Employment Type: Full-Time
About Optum
Optum is a global healthcare organization that leverages technology, data, and clinical expertise to improve health outcomes for millions worldwide. As part of UnitedHealth Group, Optum connects care delivery, pharmacy benefits, analytics, and resources to enable better, more affordable healthcare. Optum fosters an inclusive, high-performance culture with strong career development opportunities and a commitment to advancing global health.
Job Overview
The Subject Matter Expert (SME) – Medical Coding will play a critical role in ensuring the accuracy, quality, and compliance of coded medical records. This role involves auditing medical records, identifying coding discrepancies, mentoring coding professionals, and supporting continuous quality improvement initiatives. The position is ideal for experienced certified coders with strong domain expertise and leadership capabilities.
Key Responsibilities
Audit coded medical records using ICD-10-CM/PCS and CPT coding systems
Ensure strict compliance with HIPAA regulations and internal data privacy standards
Identify inconsistencies, discrepancies, and inaccuracies in medical documentation and coding; raise appropriate queries to coders and supervisors
Meet defined quality benchmarks, productivity targets, and turnaround timelines
Provide structured, educational feedback to coders on identified errors
Analyze error trends, prepare reports, and conduct targeted training sessions
Lead and participate in calibration calls involving SMEs, auditors, and trainers
Report coding malpractices or compliance risks identified during audits
Educate coding teams on coding guideline updates and regulatory changes
Review rebuttals with integrity and objective clinical judgment
Clearly differentiate between educational feedback and reportable coding errors
Adhere to company policies, employment terms, and operational directives
Required Qualifications & Experience
Education
Graduate or Postgraduate degree in Life Sciences or Allied Health Sciences, including:
BHMS, BAMS, BPT
Dental, Nursing, Pharmacy
Certifications (Mandatory)
AAPC or AHIMA certification, such as:
CPC, CPC-H, CCS, or CCS-P
Experience
Minimum 3+ years of hands-on medical coding experience in a relevant specialty
Required Skills & Competencies
Strong knowledge of medical terminology, human anatomy and physiology, and pathophysiology
Ability to interpret medications, dosages, and clinical documentation
Proven expertise in ICD-10 and CPT coding guidelines
Excellent written and verbal communication skills in English
Demonstrated ability to provide detailed, constructive feedback and coder education
Experience conducting training sessions and leading calibration discussions
Strong analytical skills with a focus on accuracy and compliance
High ethical standards and attention to detail
Why Join Optum
Work with a globally recognized healthcare and technology organization
Opportunity to influence coding quality and compliance at scale
Structured career growth and learning opportunities
Collaborative, inclusive, and performance-driven work culture
Meaningful work that directly contributes to improved patient outcomes
Apply now on thepharmadaily.com to advance your career as a Medical Coding Subject Matter Expert with Optum.
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