Assistant Director - IPDRG Payors

Access Healthcare Services Pvt Ltd; Chennai; On-site; INR 4,500,000 - 6,500,000; Full time

Job summary

Access Healthcare seeks a seasoned revenue cycle leader in Chennai to head the inpatient DRG appeals program. You will oversee clinical and coding denials across major payors, ensuring accurate DRG assignments and MCC/CC capture in line with ICD-10-CM/PCS guidelines and Coding Clinic.

15+ years of healthcare experience with IP DRG payor expertise and AHIMA CCS credential are required; leadership for a cross-border team, including Manila, is part of the role.

Qualifications

• 15+ years of progressive healthcare experience focused on IP DRG payor operations.
• Mandatory CCS credential from AHIMA.
• Leadership experience in DRG payor programs and denials management.

Responsibilities

• Lead end-to-end inpatient DRG appeals program across payors; manage DRG downgrades and clinical/coding denials.
• Ensure accurate MS-DRG/APR-DRG assignments and MCC/CC capture per ICD-10-CM/PCS guidelines and Coding Clinic.
• Direct medical record reviews to verify documentation supports DRG assignments and decide on appeals vs. denials.
• Analyze denial trends and outcomes to drive corrective action plans and improve revenue integrity.
• Provide operational guidance to the Manila team during their shift start.

Skills

Medical Coding

Analytical thinking

Strategic thinking

Communication

Team management

Education

CCS (Certified Coding Specialist) - AHIMA

Job description

We are seeking a dynamic and seasoned healthcare revenue cycle leader with expertise in IPDRG Payors based in our Chennai office. In this high-impact leadership role, you will spearhead our end-to-end inpatient DRG appeals program, overseeing complex clinical and coding validation denials across multiple payors. You will leverage your deep expertise in IPDRG payor operations, ICD-10-CM/PCS guidelines, and AHA Coding Clinics to optimize reimbursement accuracy, minimize financial leakage, and mentor our high-performing teams.

Key Responsibilities:

Appeals Leadership: Direct and oversee the end-to-end inpatient DRG appeals program, managing DRG downgrades, clinical validation denials, and coding validation denials from all major payors.

Clinical & Coding Integrity: Ensure every appeal is backed by precise MS-DRG and APR-DRG assignment, correct principal diagnosis selection, and proper MCC/CC capture in strict alignment with ICD-10-CM/PCS Official Guidelines and Coding Clinic.

Medical Record Review Oversight: Direct comprehensive medical record reviews to verify that documentation fully supports billed DRG assignments, and exercise sound judgment on when to accept versus appeal a denial.

Quality & Analytics: Analyze denial trends, overturn/change rates, and key quality parameters to develop and execute targeted corrective action plans.

Cross-Border Team Management: Provide operational leadership and guidance to the Manila team during the start of their shift.

Experience and Qualification:

15+ years of progressive healthcare experience, with a strong background as a Senior Manager, Associate Director, Deputy Director, or Director working specifically on the IP DRG payor side.

Mandatory CCS (Certified Coding Specialist) credential from AHIMA.

Key Skills

Medical Coding

Analytical and Strategic thinking

Communication

Team management

Work type:

Full-Time

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