Executives-Auditors-DRG

EXL; Chennai District; On-site; INR 1,200,000 - 1,800,000; Full time

Job summary

EXL is seeking a skilled medical coder to conduct comprehensive reviews of inpatient records, ensuring accurate ICD-10-CM/PCS coding and DRG classifications in line with IPPS and CMS guidelines.

The role includes mentoring coding staff, sharing insights with CDI specialists, and leading routine quality audits to identify trends and opportunities for improvement within the organization.

Responsibilities

• Review inpatient medical records to validate ICD-10-CM/PCS codes and DRG classifications.
• Ensure DRG assignments align with IPPS, CMS guidelines, and official coding rules.
• Verify diagnoses, procedures, POA indicators, and discharge disposition for coding decisions.
• Identify documentation gaps and coordinate with clinical teams for clarification.

Job description

Job 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