Subject Matter Expert - IPDRG

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.

Primary Responsibilities:
Auditing coded medical records using the ICD-10 and CPT
Know and adhere to HIPAA regulations
Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party, coder and supervisor
Meet auditor quality and productivity standards and deadlines/turnaround times set up for the process
Educate coders through feedback on errors
Analyze, report and conduct sessions on error trend observed
Conduct/participate/lead calibration calls between SMEs, auditors and trainers
Report malpractices noticed during auditing of any coder
Educate coders on coding updates
Carefully demarcates between educational feedback and errors.
Reviews rebuttals with integrity
Comply with all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements
Required Qualifications:
Graduate or Postgraduate
Certified coder - AAPC / AHIMA - CCS/CPC/CPC or CIC any one
6+ years of hands-on IP DRG Coding
Solid knowledge of IP-DRG methodology, ICD-10-CM/PCS guidelines, Coding Clinic guidance, and US Healthcare RCM systems
Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
Understanding of interpreting the medications and dosages
Proven good in English communication
Proven ability to provide proper and detailed feedback on errors and conduct/provide training based on error trends
Proven ability to participate/conduct/lead calibrations between SMEs, auditors and trainer group

Preferred Qualification:
Experience with provider query processes, DRG validation, and audit methodologies

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.