Director - Payors IPDRG Coding

Access Healthcare; Chennai; On-site; INR 2,500,000 - 6,000,000; Full time

Job summary

Access Healthcare in Ambattur, Chennai, seeks an experienced professional for the role of Assistant Director/Director in inpatient DRG appeals. This leadership position requires 15+ years of experience in IP DRG payor environments and a strong track record in DRG strategies and regulatory guidelines.

You will lead end-to-end DRG appeals, ensure accurate MS-DRG/APR-DRG assignments, review medical records for documentation alignment, and manage a Manila team during early shifts.

Qualifications

• Hands-on experience with IP DRG payor environments and appeals.
• Strong understanding of ICD-10-CM guidelines and Coding Clinic.
• Experience leading end-to-end DRG appeals programs.
• Ability to review medical records for accurate DRG assignment.

Responsibilities

• Lead end-to-end inpatient DRG appeals program addressing downgrades and denials.
• Ensure accurate MS-DRG and APR-DRG assignments and MCC/CC capture.
• Review medical records to confirm documentation supports DRG and decide on appeals.
• Analyze denial reasons and implement corrective action plans.
• Manage Manila team during the early shift.
• Collaborate with payors to ensure guideline compliance and audits.
• Oversee coding review and training to sustain high-quality outcomes.

Skills

IP DRG Payor

DRG Appeals Leadership

Regulatory Guidelines

Team Leadership

Job description

Designation: Assistant Director / Director

Experience: 15+ years

Location: Ambattur, Chennai

1. Should have worked in the IP DRG payor side.
2. Hands on experience in handling multiple payors and writing IP DRG appeal letters.
3. Strong payor specific guidelines understanding, ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinics, and all other regulatory guidelines.
4. Lead end-to-end inpatient DRG appeals program, covering DRG downgrades, clinical validation denials, and coding validation denials from all payors.
5. Ensure every appeal is backed by accurate MS-DRG and APR-DRG assignment, correct principal diagnosis selection, and proper MCC/CC capture under ICD-10-CM/PCS Official Guidelines and Coding Clinic.
6. Direct the review of medical records to confirm documentation supports the billed DRG and decide when a denial should be accepted rather than appealed.
7. Analyze denial reasons, change rate and other quality parameters and implement corrective action plans.
8. Available to manage Manila team during the beginning of their shift.
9. Must have CCS from AHIMA and ready to work from Chennai office.