Job Title: Subject Matter Expert (SME)
Requisition Number: 2305985
Job Category: Medical & Clinical Operations
Primary Location: Hyderabad, Telangana, India
Company Overview
Optum is a global healthcare organization leveraging technology to help millions live healthier lives. The company emphasizes inclusion, career development, and comprehensive benefits, with a mission to improve health outcomes globally.
Job Purpose
The Subject Matter Expert (SME) ensures coding accuracy and regulatory compliance in Emergency Department (ED) and Evaluation & Management (E/M) Outpatient/Inpatient (OP/IP) coding. This role supports training, audits, and continuous improvement initiatives to maintain high-quality coding standards.
Primary Responsibilities
Perform high-level coding reviews for ED and E/M OP/IP encounters.
Assign accurate CPT, ICD-10-CM, and HCPCS codes based on documentation.
Validate code selection against payer-specific guidelines and NCCI edits.
Identify trends in coding errors 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 ensure coding practices comply with current standards.
Collaborate with cross-functional teams to optimize coding workflows.
Provide SME input for system enhancements, coding tools, and automation initiatives.
Support client queries and escalations related to ED and E/M coding.
Comply with company policies, procedures, and directives, including potential reassignments or shift changes.
Required Qualifications
Certification: CPC, CCS, or equivalent.
Minimum 5 years of medical coding experience, specializing in ED and/or E/M OP/IP coding.
Experience with coding platforms and EMR systems (e.g., Epic, Cerner).
Strong understanding of coding guidelines (CPT, ICD-10-CM, HCPCS, CMS, AMA).
Excellent communication, analytical, and problem-solving skills.
Company Mission & Values
Promote equitable access to healthcare and reduce disparities.
Support inclusion, diversity, and environmental sustainability.
Enable improved health outcomes for all populations through accurate and efficient healthcare operations.
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