Manager EXL/M/1058516

3 weeks ago

Noida, India exl Full time

Job Description

This role is Individual Contributor Role and not a Team management role

Overview: The DRG Auditor is responsible for performing an in-depth review of select inpatient medical records to ensure that the assigned codes and DRG are supported by clinical documentation and all diagnoses and procedures are coded with the required specificity and the discharge disposition and the POA are correct Knowledge of IPPS methodology is required. Responsible for mentoring and training other coders. Provide ongoing feedback and education to coding staff and Clinical Documentation Specialists.

Review medical records to ensure accurate coding and billing practices in accordance with established guidelines and regulations. Identify discrepancies, errors or potential fraud in coding and billing practices. Analyze coding trends and patterns to identify areas for improvement or potential risks. Collaborate with stakeholders to address coding and billing issues and improve documentation practices. Provide feedback and education to coding staff, providers on coding guidelines, documentation guidelines and regulatory changes. Prepare audit reports summarizing findings, recommendations, and suggesting corrective and preventative actions. Stay current with updates to coding guidelines, regulations and industry best practices. Assist in developing and implementing policies, procedures and tools to support accurate coding and billing practices.

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

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

Skills and abilities:

• Auditing experience on IP DRG.

• Knowledge in Microsoft outlook/excel/word.

• Exposure on 3M software and NLP tool.

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 

• All emails from Manager should be answered promptly without fail

• Ensure compliance of entire team for HIPAA,OIG

• Good excel skills 

• Flexibility

• Good Communication

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