Subject Matter Expert

2 days ago

Hyderabad India Optum Full time

Job Description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

We are seeking experienced and detail-oriented Subject Matter Experts (SMEs) in Emergency Department (ED), Evaluation & Management (E/M) Outpatient/Inpatient (OP/IP) coding. The SME will be responsible for ensuring coding accuracy, compliance with regulatory guidelines, and supporting training and audit functions. This role is critical in maintaining high-quality coding standards and supporting continuous improvement initiatives.

Primary Responsibilities:

- Perform high-level coding reviews for ED and E/M OP/IP encounters
- Ensure accurate assignment of CPT, ICD-10-CM, and HCPCS codes based on documentation
- Validate code selection against payer-specific guidelines and NCCI edits
- Identify trends and provide feedback to improve coding 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 align with current standards
- Work with cross-functional teams to streamline 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 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:

- Certification: CPC, CCS, or equivalent
- 5+ years of experience in medical coding, with specialization in ED and/or E/M OP/IP coding
- Experience with coding platforms and EMR systems (e.g., Epic, Cerner)
- Solid understanding of coding guidelines (CPT, ICD-10-CM, HCPCS, CMS, AMA)
- Proven excellent communication, analytical, and problem-solving skills

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