Assistant Manager - Coding Auditors

Ex; Chennai District; On-site; INR 600,000 - 900,000; Full time

Job summary

EXL is seeking a DRG Auditor to conduct comprehensive audits on inpatient records, ensuring coding accuracy and compliance with ICD-10-CM/PCS and CMS guidelines. You will validate POA indicators and sequencing, mentor CDI staff, and generate actionable audit reports.

The role involves collaboration with CDI teams, physicians, and IT for process improvements, and adherence to official coding guidelines and internal SOPs.

Qualifications

• Auditing IP DRG experience required.
• CCS or CIC certification mandatory.
• Exposure to 3M software and NLP tools.

Responsibilities

• Conduct detailed DRG validation audits on inpatient records to ensure coding accuracy, completeness and compliance with ICD-10-CM/PCS and CMS guidelines.
• Review documentation to confirm diagnoses and procedures are supported and coded to the highest level of specificity.
• Validate discharge disposition, POA indicators, and sequencing of diagnoses.
• Identify and correct discrepancies between coded data and clinical documentation.
• Perform secondary reviews for complex or disputed coding cases.
• Maintain detailed audit records and prepare periodic audit reports with trends and recommendations.
• Collaborate with CDI teams, physicians, and IT/dat analytics to improve coding and auditing processes.

Skills

Auditing

DRG

MS Office

Medical Coding

Education

Bachelor's in Nursing

Bachelor's in Science

Tools

3M Software

NLP Tool

Job description

Conduct detailed DRG validation audits on selected inpatient medical records to ensure coding accuracy, completeness, and compliance with ICD-10-CM/PCS, AHA Coding Clinic, and CMS guidelines.

Review documentation to confirm that all reported diagnoses and procedures are supported and coded to the highest level of specificity.

Validate the assignment of the discharge disposition, Present on Admission (POA) indicators, and sequencing of diagnoses.

Identify and correct discrepancies between coded data and clinical documentation.

Perform secondary reviews as needed for complex or disputed coding cases.

2. Compliance and Quality Assurance

Ensure adherence to all official coding guidelines, facility policies, and payer-specific rules.

Monitor and analyze audit trends to identify coding or documentation issues impacting data quality and reimbursement.

Collaborate with the Compliance Department to address audit findings and ensure regulatory adherence.

3. Education and Mentoring

Provide ongoing feedback and coaching to coders and Clinical Documentation Improvement (CDI) Specialists to enhance coding accuracy and documentation quality.

Develop and deliver targeted training sessions on DRG optimization, clinical indicators, coding guidelines, and audit findings.

Serve as a resource for complex coding questions and provide interpretation of regulatory updates and coding guideline changes.

4. Reporting and Documentation

Maintain detailed and accurate records of all audit activities and findings.

Prepare periodic audit reports summarizing trends, root causes, and recommendations for improvement.

Communicate results to management and participate in performance improvement initiatives.

Work closely with CDI teams, physicians, and other clinical staff to clarify documentation and ensure accurate code assignment.

Partner with IT and data analytics teams to improve coding and auditing processes.

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

Qualifications

Skills and abilities

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

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

• Auditing experience on IP DRG.
• Exposure on 3M software and NLP tool.

Required Skills

• Audit Analytics
• DRG
• MS OFFICE Software
• Medical Coding

About Us

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com .