is hiring IPDRG

4 weeks ago

Hyderabad Chennai Bengaluru, India EXL Full time
Job Description

Certifications:

1. CPC -Certified Professional
2. CCS -Certified Coding Specialist
3. CIC -Certified Inpatient Coder

Experience:

Manager:10 to 15 years experience in medical coding, auditing and automation.

Skills and Abilities:

1. Advanced knowledge of medical coding software platforms (e.g., 3M Code Finder, Optum360, True Code, Epic, Cerner, etc.).
2. Minimum 5 years of experience in Inpatient DRG coding.
3. Outpatient medical coding experience is added advantage.
4. Mandatory working experience on US healthcare automation projects.
5. Knowledge on automation tools
6. Knowledge of programming language would be added advantage alike.
7. Python
8. SQL
9. R, etc.
10. Payer experience is added advantage.
11. Expertise in Microsoft outlook/excel/word/Power BI.

Primary Roles and Responsibilities:

- Automation of DRG Coding to streamline repetitive coding tasks.
- Bringing AI based solutions for DRG claims validations.
- Improve compliance through predictive analytics.
- AI-Assisted decision-making automations for diagnosis and procedure codes.
- Ability to work with physicians, IT professionals, SMEs, and medical coders.
- Solutions to automatically recognize and extract data from medical records to facilitate auditing.
- Workflows Optimization.
- Conducting UAT and providing feedback to the respective teams.
- Retraining and evaluating the performance of the automated model.

1. Estimating or projecting the return on investment (ROI).
2. Perform analysis of benchmarking.

Additional Roles and Responsibilities:

- Oversee operations of healthcare facilities.
- Manage staffing, scheduling, and resource allocation
- Stay updated on changes in healthcare.
- Develop and implement quality improvement initiatives.
- Strategic planning process to align organizational goals.
- Engage in market analysis to understand the competitive landscape.
- Maintaining SOP and Audit manual.
- Track key performance indicators (KPIs).

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