Optum is a powerhouse in the healthcare industry, part of the UnitedHealth Group family, serving millions worldwide with innovative solutions in data analytics, pharmacy benefits, and clinical services. With a strong presence in India, Optum’s Pune office is at the heart of its operations, driving advancements in risk adjustment coding and quality assurance for global clients. The company emphasizes employee growth, work-life balance, and cutting-edge technology to enhance patient care and operational efficiency.
Optum’s commitment to excellence has made it a top employer for Quality Assurance Specialists in the medical coding sector. Whether you’re passionate about ICD-10-CM guidelines, AHA coding clinic updates, or root cause analysis in coding projects, Optum offers a collaborative environment with opportunities for professional development. Join Optum and contribute to transforming healthcare – from Medicare compliance to commercial risk models – while advancing your career in Pune’s thriving job market.
Detailed Job Description: Certified Quality Assurance Specialist at Optum Pune
Optum is seeking dedicated Certified Quality Assurance Specialists to ensure top-tier accuracy in HCC Risk Adjustment Coding projects. This role demands a blend of technical expertise, analytical prowess, and training skills to maintain compliance and drive quality improvements. Below is the comprehensive job description for this Quality Assurance Jobs in Pune position.
Key Roles & Responsibilities:
- Expertise in Risk Adjustment Models: Possess in-depth knowledge of Medicare and Commercial risk adjustment models to support accurate coding and reimbursement processes.
- Coding Standards Proficiency: Stay well-versed in ICD-10-CM guidelines, AHA coding clinic updates, and client-specific requirements to uphold industry best practices.
- QA Audits and Sampling: Perform QA audits across multiple projects and derive effective QA sampling and audit methodologies tailored to assigned initiatives.
- Analytical Monitoring: Use strong analytical skills to monitor and measure quality trends in coding projects, identifying areas for enhancement.
- Root Cause Analysis and Training: Conduct root cause analysis, pinpoint knowledge gaps, and deliver targeted training to project teams for sustained performance.
- Project Onboarding and Delivery: Review scope documents and guidelines for new clients, own pilot project delivery to meet client SLA on quality, and ensure seamless project launches.
- Guideline Customization: Review and customize standard coding guidelines as per project needs to optimize efficiency.
- Error Trend Identification: Analyze error trends from client feedback and implement continuous improvements to enhance client experience.
- Training Sessions: Lead sessions on audit protocols, comment matrix, and best practices for prospective auditors to build team capabilities.
- Query Resolution: Respond to internal coding queries with clear rationale, ensuring alignment with standards.
- Compliance Adherence: Follow all external and internal compliance standards to mitigate risks and maintain regulatory integrity.
This role is ideal for professionals who thrive in fast-paced environments, combining Quality Auditing with strategic quality management in HCC Risk Adjustment Coding.
Education, Experience, and Certifications Required:
- Educational Background: A degree in Life Sciences or Medical/Paramedical Sciences is essential.
- Work Experience: Minimum 3+ years in HCC Risk Adjustment Coding, including at least 6 months in Quality Sampling and Quality Auditing.
- Certifications: Valid AAPC or AHIMA certification is mandatory to qualify for this Quality Assurance Specialist position.
If you meet these criteria and are excited about Optum careers in Pune, this is your chance to excel in a role that directly impacts healthcare quality and efficiency.
How to Apply for Certified Quality Assurance Specialist Jobs at Optum Pune
Ready to take the next step in your Quality Assurance career? Applying is straightforward. Interested candidates should send their updated resumes and cover letters highlighting relevant HCC Risk Adjustment Coding experience to the following points of contact (POCs) at Optum:
- Sowndharya Boopathi: sowndharya.boopathi@optum.com
- Ashraff Shaik: ashraffshaik.mohammad@optum.com
- Rajalakshmi Sampath: rajalakshmi.sampath@optum.com