Quality Auditor- E/m

1 month ago

Hyderabad Telangana, India Optum Full time

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start** Caring. Connecting. Growing together.**

**Primary Responsibilities**:

- The SME will support the coding area by accurately coding the medical records
- Job is aligned to HIM services that requires understanding of the medical terminology and ability to interpret physician and nurse notes
- Codes outpatient records and identifies diagnoses and procedures daily according to the schedule set within the coding unit
- The Coder accurately assigns ICD-10 and/or CPT-4 codes in accordance with Coding guidelines and SLA/organization targets
- Consistently strives for efficiency and thrives to meet the targets
- Demonstrates willingness and flexibility in working additional hours or changing hours whenever required between normal business hours
- Demonstrates thorough understanding on how his work impacts the project / end customer
- Demonstrates a good rapport and works to establish cooperative working relationships with all members of the team
- Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party and supervisor
- Meet quality and productivity standards and deadlines/turnaround times
- Participate in Quality Improvement Activities
- Performs other duties as assigned by supervisor
- Reports a discharge disposition for all records as required and in accordance with the Centers for Medicare and Medicaid Services (CMS) rules and regulations
- Assigns and reports all other data elements required for Statewide Planning and Research Cooperative System (SPARCS) data collection
- For outpatient encounters, applies coding conventions and official coding guidelines approved by the Current Procedural Terminology (CPT) rules established by the American Medical Association (AMA), and any other official rules and guidelines established for use with the mandated outpatient procedure code sets
- Assigns appropriate discharge physician in the system
- Maintains the minimum data standards for accuracy and productivity as per defined KRAs/ Client SLAs
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

**Required Qualifications**:

- Must be a graduate
- Certified coder - AAPC / AHIMA - CCS/CPC/CPC-H/CCS-P
- Minimum working experience of 5+ yrs as quality auditor for E/M OP IP OR Ed Profee & Facility
- Proven good in English communication
- Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
- Working knowledge of Excel and Microsoft Office products
- Thorough understanding of the Medical record formats
- Understanding of interpreting the medications and dosages
- Coding the medical record using the ICD-10 and CPT with desired accuracy as per SLA
- Know and adhere to HIPAA regulations
- At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission._

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