Subject Matter Expert - IPDRG

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.

Job Details
Job Field: Medical & Clinical Operations
Organization: OOG Human Capital
Schedule: Full-time
Shift: Day Job
Telecommuter Position: No
Overtime Status: Exempt