Inpatient Drg Coding Expert

**Inpatient DRG Coding Expert**:
**We Are Hiring**: Inpatient-DRG Coding Experts - Documentation Excellence, Case Mix Index Integrity, and Reimbursement Accuracy

**Doctus Data Services Pvt. Ltd**. is expanding its Inpatient (IP) DRG Coding practice and seeking 20+ experienced IP-DRG Coding Experts to join our growing team. This is not a standard coding role; it is an opportunity to lead denial prevention, optimize coding accuracy, and enhance Case Mix Index (CMI) while driving quality and financial outcomes for leading United States health systems.

**Why This Role Matters Now**:

- Healthcare Challenge**:_ Rapidly rising denial rates. Your Impact: Deliver clean, audit-proof claims through proactive documentation and coding alignment that protects Case Mix Index (CMI).**:

- Healthcare Challenge**:_ Reimbursement compression from Medicare Advantage and commercial payers Your Impact: Optimize DRG assignment to reflect true acuity and maintain accurate CMI.**:

- Healthcare Challenge**:_Quality-linked penalties (PSIs, readmissions, HACs) Your Impact: Improve coding accuracy that drives CMS quality metrics while sustaining accurate CMI.**:

- Healthcare Challenge**:_ AI-driven audits and automated denials Your Impact: Stay ahead with clinically nuanced, precision-driven coding that ensures CMI integrity under scrutiny.

**About the Role**:
We are seeking seasoned inpatient coding experts who translate complex clinical documentation into accurate ICD-10-CM/PCS codes and defensible MS-DRG/APR-DRG assignments. Your work will directly impact CMI, SOI, ROM, CC/MCC capture, reimbursement accuracy, quality reporting, and audit readiness. This role goes beyond assigning codes — you will partner with Client CDI teams, educate providers, and ensure that every claim reflects true acuity and resource utilization.

**What You Will Do**:

- Own Case Mix Index performance**:_ Assure accurate CMI through precise SOI and ROM leveling and consistent CC/MCC capture across complex inpatient encounters.
- Champion documentation integrity: Validate ICD-10-CM/PCS coding and final DRG assignment with a CMI-first lens.**:

- Drive query excellence**:_Close documentation gaps with clinically focused, audit-ready queries that support defensible CMI uplift.**:

- Lead compliance and education**_: Advise on DRG logic, POA indicators, and quality metrics (HAC, PSI, mortality), and deliver targeted provider education to sustain CMI gains.**:

- Prevent denials proactively**_: Implement pre-bill workflows; conduct root-cause analyses for DRG downgrades, payer rejections, and RAC triggers to protect CMI and revenue integrity.**:

- Analyze and act on trends**_: Monitor DRG shifts, outlier cases, low-acuity patterns, and under-captured CC/MCC opportunities; escalate findings with clear recommendations.**:

- Partner for impact**_: Collaborate with United States revenue cycle leaders to align coding practices with value-based metrics and CMI-linked performance goals.
- Stable or improving monthly CMI trend by service line
- CC/MCC capture rate improvement with sustained SOI/ROM accuracy
- Reduction in DRG downgrades and avoidable payer takebacks affecting CMI
- Increased audit sustainment rate for clinically validated queries and DRG assignments

**Tools and Platforms You Will Work With**:

- EMRs**_: EpicCare Inpatient, Oracle Cerner, Meditech**:

- Coding and CAC**:_ Solventum 3M 360 CAC, Microsoft/Nuance, Optum EncoderPro**:

- Analytics**_: SQL-based audit tracking, Excel-based CMI and DRG-shift dashboards**:

- Collaboration**:_ CDI portals and denial-resolution playbooks

**What You Will Bring**:

- Minimum Experience**:_ At least 8 years of hands-on United States inpatient CDI and DRG coding experience with deep expertise in ICD-10-CM/PCS, MS-DRG, and APR-DRG logic.**:

- Education**:_ Graduate or Postgraduate degree in Life Sciences (Physicians or Registered Nurses preferred).**:

- Certifications**:_CCS, CDIP, CCDS, CIC, or equivalent (multiple credentials are a plus).**:

- Systems Expertise**:_Epic, Oracle Cerner, Meditech, Solventum, Nuance, Optum.
- _ **Knowledge**_**:HAC/PSI indicators, POA status, CMI optimization, clinical validation, and audit readiness.**:

- Soft Skills**:_ Strong analytical mindset, consultative communication style, and the ability to translate data into CMI-impacting actions.**:

- Work Mode**_**: Work From Office - Hyderabad Location.

**Why Join Doctus**:

- Impact at scale**_— Influence CMI, quality scores, reimbursement accuracy, and patient outcomes for leading United States health systems.
- _**Collaborative culture**_— Join an expert team that values transparency, learning, and continuous growth.**:

- Career acceleration**_— Access credentialing sponsorship, advanced CDI analytics, and leadership development pathways.
- _**Comprehensive package**_— Industry-leading compensation, credentialing support, and performance incentives.

**Job Types**: Full-time, Permanent

**Benefits**:

- Health insuranc