Executives-Auditors-DRG

2 days ago

Chennai, Tamil Nadu, India EXL Full time
Description

  Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures.

  Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines, and official coding rules when determining DRG assignment.

  Verify accuracy and specificity of diagnoses, procedures, POA indicators, and discharge disposition, ensuring documentation supports all coding decisions.

  Identify documentation gaps and collaborate with clinical teams to obtain necessary clarifications for accurate code assignment.

  Mentor, coach, and support coding staff, providing guidance on complex DRG and inpatient coding scenarios.

  Deliver feedback and ongoing education to both coders and Clinical Documentation Improvement (CDI) specialists to improve coding quality and documentation completeness.

  Perform routine coding quality audits to assess accuracy, identify trends, and recommend corrective actions.

  Analyze audit findings and prepare detailed reports, highlighting errors, patterns, and opportunities for improvement.

  Stay updated on regulatory changes, payer guidelines, and industry best practices related to IPPS, DRG validation, and inpatient coding.

  Participate in cross-functional meetings with coding, CDI, compliance, and operations teams to strengthen documentation and coding accuracy across the organization

Responsibilities

ADDITIONAL AND ESSENTIAL RESPONSIBILITIES:


• Follow every aspect of SOP without fail 


• Complete received Audits with Quality


• To achieve Quality and production target


• Follow project related protocols  and instructions 


• Escalate issues, identify trends...


• Update all the logs like productivity, Clarification log, and any other logs applicable, daily 


• Check with Manager /TL in case of clarifications 


• All emails from Manager should be answered promptly without fail


• Ensure compliance of entire team for HIPAA,OIG


• Good excel skills 


• Flexibility


• Good Communication



Qualifications

 Qualifications: Bachelors in nursing preferable / bachelor's in science.

Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder

 Experience: Minimum 2 years' experience in IP DRG coding or auditing.

 Working Hours: 40 HOURS PER WEEK, FULL TIME EMPLOYEE

Skills and abilities:


• Auditing experience on IP DRG.


• Knowledge in Microsoft outlook/excel/word.


• Exposure on 3M software and NLP tool.

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