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Subject Matter Expert

2 months ago

Flower Bazaar, 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 scoresConfirm Admission-Discharge-Transfer (ADT) information and correct when necessarySuggest 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/ManagerKeep 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 skillsDemonstrates 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