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Quality Auditor- E/M & E/D

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Optum

Nov 4

Applications are closed

  • Job
    Full-time
    Senior Level
  • Data
    Healthcare
  • Hyderabad, +1

Requirements

  • Must be a graduate
  • Certified coder - AAPC / AHIMA - CCS/CPC/CPC-H/CCS-P
  • Minimum working experience of 5+ yrs as quality auditor for E/M OP IP OR Ed Profee & Facility
  • Proven good in English communication
  • Thorough knowledge of medical terminology, human anatomy/ physiology, pathophysiology
  • Working knowledge of Excel and Microsoft Office products
  • Thorough understanding of the Medical record formats
  • Understanding of interpreting the medications and dosages
  • Coding the medical record using the ICD-10 and CPT with desired accuracy as per SLA
  • Know and adhere to HIPAA regulations

Responsibilities

  • The SME will support the coding area by accurately coding the medical records
  • Job is aligned to HIM services that requires understanding of the medical terminology and ability to interpret physician and nurse notes
  • Codes outpatient records and identifies diagnoses and procedures daily according to the schedule set within the coding unit
  • The Coder accurately assigns ICD-10 and/or CPT-4 codes in accordance with Coding guidelines and SLA/organization targets
  • Consistently strives for efficiency and thrives to meet the targets
  • Demonstrates willingness and flexibility in working additional hours or changing hours whenever required between normal business hours
  • Demonstrates thorough understanding on how his work impacts the project / end customer
  • Demonstrates a good rapport and works to establish cooperative working relationships with all members of the team
  • Recognize, interpret and evaluate inconsistencies, discrepancies and inaccuracies in the medical data received and appropriately alert and/or query the responsible party and supervisor
  • Meet quality and productivity standards and deadlines/turnaround times
  • Participate in Quality Improvement Activities
  • Performs other duties as assigned by supervisor
  • Reports a discharge disposition for all records as required and in accordance with the Centers for Medicare and Medicaid Services (CMS) rules and regulations
  • Assigns and reports all other data elements required for Statewide Planning and Research Cooperative System (SPARCS) data collection
  • For outpatient encounters, applies coding conventions and official coding guidelines approved by the Current Procedural Terminology (CPT) rules established by the American Medical Association (AMA), and any other official rules and guidelines established for use with the mandated outpatient procedure code sets
  • Assigns appropriate discharge physician in the system
  • Maintains the minimum data standards for accuracy and productivity as per defined KRAs/ Client SLAs
  • 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

FAQs

What qualifications are required for the Quality Auditor position?

The position requires a graduate degree and certification from AAPC or AHIMA as CCS/CPC/CPC-H/CCS-P, along with a minimum of 5 years of experience as a quality auditor for E/M OP IP or Ed Profee & Facility.

Is prior experience necessary for this role?

Yes, a minimum of 5+ years of working experience as a quality auditor is required.

What coding standards are utilized in this position?

The coder will utilize ICD-10 and CPT coding standards in accordance with established guidelines and SLA targets.

Are there opportunities for professional growth?

Yes, there are comprehensive benefits and career development opportunities available within the organization.

What skills are necessary for success in this role?

Candidates should have thorough knowledge of medical terminology, human anatomy/physiology, pathophysiology, and proficiency in Excel and Microsoft Office products.

Do I need to adhere to any privacy regulations?

Yes, it is essential to know and adhere to HIPAA regulations in this position.

What is the focus of the work performed in this position?

The work involves accurately coding medical records, meeting quality and productivity standards, and participating in quality improvement activities.

Is there any flexibility in work hours for this role?

Yes, the role requires a willingness to work additional hours or modify hours as necessary to meet project demands.

Will I be involved in quality improvement activities?

Yes, the position includes participation in Quality Improvement Activities as part of the responsibilities.

What company values are emphasized in this role?

The organization is guided by diversity and inclusion and is committed to advancing health equity on a global scale.

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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.

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