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Optum
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Subject Matter Expert

Subject Matter Expert

Optum

5 - 10 years

4 - 9 Lacs

hyderabad

Posted:Just now| Platform:

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Skills Required

subject matter expert medical inpatient cms epic emr emergency department outpatient employment contract medical coding automation regulatory changes compliance cpc

Work Mode

Work from Office

Job Type

Full Time

Job Description

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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Subject Matter Expert