IPDRG Coder / DRG Validation Specialist

Saaki Argus And Averil Consulting; Hyderabad; On-site; INR 420,000 - 720,000; Full time

Job summary

Saaki Argus And Averil Consulting in India is seeking a DRG coding reviewer to ensure inpatient coding accuracy and compliance. You will review medical records to assign ICD-10-CM/PCS, CPT codes and accurate DRGs, adhering to CMS and payer guidelines.

You will identify documentation gaps, collaborate with physicians, and help maintain quality, accuracy, and productivity targets while staying current with DRG methodologies and coding guidelines.

Qualifications

• Experience in inpatient medical coding and revenue cycle processes.
• Proficiency with ICD-10-CM/PCS, CPT coding and DRG methodologies.
• Knowledge of CMS and payer-specific guidelines.

Responsibilities

• Review inpatient records to assign and validate codes.
• Ensure coding accuracy and compliance with guidelines and payer standards.
• Identify documentation gaps and collaborate with physicians for clarification.
• Meet defined quality, accuracy, and productivity targets.
• Conduct DRG validation reviews and document findings.
• Provide recommendations for coding accuracy and process improvement.

Skills

Inpatient coding

ICD-10-CM/PCS coding

CPT coding

DRG validation

CMS guidelines

Documentation review

Quality focus

Job description

IPDRG CodingReview inpatient medical records and accurately assign ICD-10-CM, ICD-10-PCS, CPT, and DRG codes.Ensure coding accuracy and compliance with established coding guidelines, regulatory requirements, and payer standards.Review clinical documentation to identify appropriate coding opportunities.Ensure accurate capture of MCCs, CCs, diagnoses, and procedures.Meet defined quality, accuracy, and productivity targets.Identify documentation gaps and collaborate with physicians/clinical teams for appropriate clarification.Maintain up-to-date knowledge of ICD-10 coding guidelines and DRG methodologies.DRG ValidationConduct detailed DRG validation reviews of inpatient medical records.Validate diagnoses, procedures, MCC/CC capture, and overall DRG assignment.Identify coding discrepancies, clinical validation issues, and potential reimbursement risks.Review clinical documentation to ensure diagnoses are clinically supported and appropriately coded.Ensure compliance with CMS, ICD-10, payer-specific guidelines, and reimbursement methodologies.Conduct quality audits and document findings accurately.Provide recommendations for coding accuracy, compliance, and process improvement.