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Subject Matter Expert

3 months ago


Chennai, India Optum Full time

Optum - A UHG Company is hiring Subject Matter Expert (ED Profee and Facility).


Please find below details of the same


Job Description


  • Review, analyze and interpret the entire electronic medical record for the current admission to identify all diagnoses and procedures documented during the admission.
  • Determine and assign the principal and significant secondary ICD-10-CM diagnosis codes, in addition to present on admission indicators, and ICD-10-PCS procedure codes, using official coding guidelines and knowledge of anatomy and physiology, pharmacology and pathophysiology/disease processes.
  • Identify cases with clinical indicators that may require provider documentation clarification and/or specificity in order to accurately assign codes; collaborate with CDIS team as part of the clinical documentation validation and physician query workflows.
  • Analyze code assignment and sequence to assure proper assignment; sequence codes in compliance with ICD-10 Official Coding Guidelines, Uniform Hospital Discharge Data Set (UHDDS) and other regulatory requirements to accurately assign.
  • Analyze medical record documentation for optimum severity of illness and risk of mortality scores
  • Confirm Admission-Discharge-Transfer (ADT) information and correct when necessary
  • Suggest and assist with workflow process improvements as appropriate. Participate in coding quality and productivity processes.
  • Identify topics of high priority for training and clarification and refer to the Supervisor/Manager
  • Keep abreast of annual and periodic updates to the ICD-10 coding system and regulations to provide expert coding advice to colleagues.


Required Skill Set


  • Knowledge of, but not limited to, current Official Coding Guidelines and methodologies , the ICD-10-CM/PCS coding systems and conventions.
  • Extensive knowledge of medical terminology, anatomy and pathophysiology, pharmacology and ancillary test results
  • In-depth knowledge of complex medical and coding concepts encountered in an Academic Medical Canter.
  • Strong communication skills (interpersonal, verbal and written).
  • Serve as a subject matter expert to Clinical Documentation Improvement Specialists, colleagues and clinicians.
  • Strong analytical thinking skills
  • Demonstrates critical thinking skills, and ability to interpret, assess, and evaluate provider documentation.
  • Proficient with Microsoft Office applications (Outlook, Word, Excel)
  • Self-motivated and demonstrated capacity to work independently without close supervision. This position has the potential to work remotely.
  • Must be able to work flexible hours which may include weekends as required to meet business needs.
  • Ability to quickly analyze a situation, problem solve and prioritize.
  • Familiarity with the external reporting aspects of healthcare
  • Knowledge of external auditing programs; ex.: Recovery Audit Contractor (RAC), Office of the Inspector General (OIG), third-party payors.


If you are interested in this role, please mail your CV to kirti_dhamija@optum.com