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Subject Matter Expert

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Optum

2mo ago

  • Job
    Full-time
    Senior Level
  • Data
    Healthcare
  • Chennai
    Remote

AI generated summary

  • You need a Life Science degree, CPC/CCS certification, 5+ years in coding/auditing, knowledge of ICD-10, strong analytical skills, and the ability to work independently and communicate effectively.
  • You will independently review medical records, assign diagnosis and procedure codes, collaborate on documentation issues, analyze coding accuracy, and suggest workflow improvements.

Requirements

  • Life Science or Allied Medicine Graduates with certification from AAPC or AHIMA
  • CPC/CCS Certified
  • 5+ years in coding and audit experience
  • Extensive work experience within own function
  • Knowledge of, but not limited to, current Official Coding Guidelines and methodologies, the ICD-10-CM/PCS coding systems and conventions
  • Knowledge of external auditing programs; ex.: Recovery Audit Contractor (RAC), Office of the Inspector General (OIG), third-party payors
  • 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 Center
  • Familiarity with the external reporting aspects of healthcare
  • Medical Coding background
  • Proficient with Microsoft Office applications (Outlook, Word, Excel)
  • Proven solid communication skills (interpersonal, verbal and written)
  • Proven ability to serve as a subject matter expert to Clinical Documentation Improvement Specialists, colleagues and clinicians
  • Proven solid analytical thinking skills
  • Demonstrated critical thinking skills, and ability to interpret, assess, and evaluate provider documentation
  • Proven self-motivated and demonstrated capacity to work independently without close supervision. This position has the potential to work remotely
  • Proven ability to work flexible hours which may include weekends as required to meet business needs
  • Proven ability to quickly analyze a situation, problem solve and prioritize
  • Proven ability to review, analyze and interpret the entire electronic medical record for the current admission to identify all diagnoses and procedures documented during the admission
  • Proven ability to 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
  • Proven ability to 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
  • Proven ability to 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
  • Proven ability to analyze medical record documentation for optimum severity of illness and risk of mortality scores
  • Proven ability to confirm Admission-Discharge-Transfer (ADT) information and correct when necessary
  • Proven ability to suggest and assist with workflow process improvements as appropriate. Participate in coding quality and productivity processes
  • Proven ability to identify topics of high priority for training and clarification and refer to the Supervisor/Manager
  • Proven ability to keep abreast of annual and periodic updates to the ICD-10 coding system and regulations to provide expert coding advice to colleagues

Responsibilities

  • Works independently
  • May act as a resource for others
  • May coordinate others' activities
  • 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
  • Proven ability to review, analyze and interpret the entire electronic medical record for the current admission to identify all diagnoses and procedures documented during the admission
  • Proven ability to 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
  • Proven ability to 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
  • Proven ability to 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
  • Proven ability to analyze medical record documentation for optimum severity of illness and risk of mortality scores
  • Proven ability to confirm Admission-Discharge-Transfer (ADT) information and correct when necessary
  • Proven ability to suggest and assist with workflow process improvements as appropriate. Participate in coding quality and productivity processes
  • Proven ability to identify topics of high priority for training and clarification and refer to the Supervisor/Manager
  • Proven ability to keep abreast of annual and periodic updates to the ICD-10 coding system and regulations to provide expert coding advice to colleagues

FAQs

What is the role of a Subject Matter Expert (SME) in this position?

The SME is responsible for reviewing documentation in the electronic medical record and assigning and sequencing ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes, while ensuring compliance with coding guidelines and regulations.

What qualifications are required to apply for the job?

Applicants must be Life Science or Allied Medicine Graduates with certification from AAPC or AHIMA, possess a CPC/CCS certification, and have at least 5 years of coding and audit experience.

What are the primary responsibilities of this position?

Primary responsibilities include working independently, acting as a resource for others, coordinating activities, and complying with company policies and directives.

Is knowledge of ICD-10 coding required for this position?

Yes, extensive knowledge of ICD-10-CM/PCS coding systems, Official Coding Guidelines, and medical terminology is required.

What kind of experience is preferred for a candidate?

Candidates should have in-depth knowledge of complex medical and coding concepts encountered in an Academic Medical Center, along with familiarity with external auditing programs.

Are there opportunities for career development in this position?

Yes, the organization offers comprehensive career development opportunities as part of its commitment to employee growth.

Is flexibility in work hours required for this position?

Yes, candidates must be able to work flexible hours, which may include weekends, to meet business needs.

Will the SME be involved in collaboration with other teams?

Yes, the SME will collaborate with the Clinical Documentation Integrity Specialist (CDIS) team regarding clinical validation queries and the reconciliation process.

What skills are necessary for effective communication in this role?

Proven solid communication skills (interpersonal, verbal, and written) are necessary, along with the ability to serve as a subject matter expert to colleagues and clinicians.

How does this role contribute to health equity?

The work performed by the SME directly improves health outcomes by ensuring accurate coding and documentation, which supports equitable access to care for all individuals.

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Optum

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

Optum is a health services and technology company that provides a wide range of solutions to improve healthcare delivery and outcomes. They offer services in healthcare management, data analytics, pharmacy benefit management, and technology solutions to healthcare providers, payers, employers, and government agencies. Optum's ultimate mission is to improve the health system's efficiency and effectiveness, creating a healthier world for everyone. Their purpose lies in collaborating with healthcare partners to address complex challenges, such as improving care coordination, reducing healthcare costs, and enhancing patient experiences. By leveraging data-driven insights and innovative technology, Optum aims to empower healthcare professionals and organisations to deliver high-quality, patient-centered care and drive positive healthcare outcomes for individuals and communities worldwide.

Culture & Values

  • Integrity

    Honour commitments. Never compromise ethics.

  • Compassion

    Walk in the shoes of people we serve and those with whom we work.

  • Relationships

    Build trust through collaboration.

  • Innovation

    Invent the future, learn from the past.

  • Performance

    Demonstrate excellence in everything we do.