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 insurance
• Provident Fund

Work Location: In person