Instagram
youtube
Facebook

Subject Matter Expert – Surgery Coding

5 years
Not Disclosed
10 Nov. 20, 2025
Job Description
Job Type: Full Time Education: B.Sc./ M.Sc./ M.Pharm/ B.Pharm/ Life Sciences Skills: Causality Assessment, Clinical SAS Programming, Communication Skills, CPC Certified, GCP guidelines, ICD-10 CM Codes, CPT-Codes, HCPCS Codes, ICD-10 CM, CPT, HCPCS Coding, ICH guidelines, ICSR Case Processing, Interpersonal Skill, Labelling Assessment, MedDRA Coding, Medical Billing, Medical Coding, Medical Terminology, Narrative Writing, Research & Development, Technical Skill, Triage of ICSRs, WHO DD Coding

Subject Matter Expert – Surgery Coding

Location: Noida, Uttar Pradesh, India
Job Category: Medical & Clinical Operations
Requisition Number: 2324244
Experience Required: Minimum 5 years of medical coding experience with specialization in Surgery Coding
Employment Type: Full-Time


About the Role

Optum, a global leader in technology-enabled healthcare, is seeking an experienced Subject Matter Expert (SME) – Surgery Coding to support coding accuracy, guideline updates, quality improvement, and coder development across surgery coding functions. This role is essential in maintaining compliance, strengthening coding capabilities, and ensuring high-quality documentation within the healthcare revenue cycle.

As part of Optum’s expert coding team, you will provide advanced training, coding clarification, audit support, and guidance on surgery-specific coding scenarios to enhance operational performance and coding excellence.


Key Responsibilities

Training, Coaching & Knowledge Enhancement

  • Develop and deliver training programs for coding professionals focused on Surgery coding, including CPT, ICD-10-CM, HCPCS, and NCCI guidelines.

  • Stay current with coding updates from CMS, AMA, AHA Coding Clinics, and communicate changes to the team.

  • Provide guidance on documentation improvement and complex coding scenarios.

Quality, Compliance & Audit Support

  • Track coder assessment scores, audit results, and overall coding performance.

  • Conduct quality reviews, offer detailed feedback, and ensure consistent accuracy in coding submissions.

  • Participate in coding calibration meetings and contribute expert insights.

  • Work closely with compliance, QA, and operations teams to identify gaps and support continuous improvement.

Operational Coordination & Reporting

  • Prepare accurate reports and maintain detailed records related to training, audits, and coding updates.

  • Support coders with coding clarifications, documentation interpretations, and case-specific guidance.

  • Ensure adherence to company policies, work location requirements, shift flexibility, and operational changes as required.


Required Qualifications

Education

  • Bachelor’s degree in Health Information Management, Life Sciences, or a related field (preferred).

Certifications

  • Valid AAPC or AHIMA certification is mandatory:

    • CPC

    • CIC

    • CCS

    • COC

Experience

  • Minimum 5+ years of proven medical coding experience, with strong expertise in Surgery Coding.

  • In-depth knowledge of Surgery and Evaluation & Management (E/M) guideline updates.

  • Strong understanding of US Healthcare Revenue Cycle Management (RCM).

  • Experience using EMR/EHR systems and auditing platforms such as EPIC, eCAC, 3M, and Cerner.


Skills & Competencies

  • Comprehensive understanding of medical terminology, anatomy, and physiology.

  • Strong accuracy, attention to detail, and documentation review skills.

  • Excellent communication and presentation skills.

  • Ability to support teams in complex case resolution and guideline clarification.


Why This Role Is Important

This role is essential for ensuring coding accuracy, maintaining compliance with evolving regulatory requirements, and elevating coding performance across surgery-related healthcare documentation. It provides an opportunity to influence process improvements and support large-scale healthcare operations within a globally recognized organization.