Ipdrg QAs

5 days ago

Chennai Tamil Nadu, India Raghav IT Solution Services OPC Pvt. Ltd Full time

The IPDRG QA is responsible for performing quality assurance reviews of inpatient medical records to ensure accurate assignment of DRGs, ICD-10-CM/PCS codes, and alignment with coding and clinical documentation standards. This role supports compliance with federal coding guidelines, regulatory requirements, and revenue cycle integrity.

**Key Responsibilities**:

- Perform retrospective and concurrent quality reviews of inpatient coding and DRG assignments.
- Validate accurate and complete coding (ICD-10-CM/PCS) based on clinical documentation.
- Review and audit DRG assignments to ensure appropriate severity of illness (SOI), risk of mortality (ROM), and reimbursement.
- Collaborate with coding teams and clinical documentation specialists to identify and resolve discrepancies.
- Provide feedback and training to coders regarding errors, trends, and best practices.
- Ensure compliance with CMS guidelines, AHA Coding Clinic guidance, and facility policies.
- Maintain up-to-date knowledge of coding changes, DRG grouping logic, and regulatory requirements.
- Utilize computer-assisted coding (CAC) tools, encoder systems, and EHRs to perform audits.
- Assist in developing quality improvement plans based on audit findings.
- Generate reports and dashboards for leadership on coding accuracy and DRG performance metrics.

**Qualifications**:

- RHIA, RHIT, CCS, or equivalent AHIMA certification required.
- Minimum of 3-5 years of inpatient coding and/or DRG auditing experience.
- In-depth knowledge of ICD-10-CM/PCS, DRG reimbursement methodologies, and CMS regulations.
- Strong analytical, problem-solving, and communication skills.
- Experience with hospital information systems, EHRs, and CAC tools (e.g., 3M, Optum).

Pay: ₹40,000.00 - ₹80,000.00 per month

**Education**:

- Bachelor's (required)

**Experience**:

- IPDRG QAs: 3 years (required)

License/Certification:

- CPC, CCS, or CIC (required)

**Location**:

- Bangalore, Karnataka (required)

Work Location: In person

**Speak with the employer**
+91 9570805386

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