QA - HIM Services

CorroHealth, Inc.; Hyderabad; Presencial; INR 1.200.000 - 1.800.000; Jornada completa

Descripción de la vacante

CorroHealth, Inc. is seeking a Quality Auditor – Inpatient DRG with 5–10 years of medical coding experience, including at least 3 years in inpatient DRG coding and auditing.

The role focuses on validating MS-DRG/APR-DRG assignments, performing pre-bill audits, and collaborating with CDI teams to ensure compliant guidance and optimal reimbursements. The candidate will review inpatient records, verify diagnoses and procedures, ensure POA accuracy, and support denials management while staying

Formación

• Bachelor’s/Master’s in Life Sciences required.
• CCS or CIC certification highly valued for IP coding.
• 5+ years in medical coding with inpatient DRG focus preferred.

Responsabilidades

• DRG validation: verify principal diagnosis per Official Coding Guidelines.
• MCC/CC verification to reflect DRG weight and hospital payment.
• Audit ICD-10-PCS for root operation, approach, and body part accuracy.
• POA indicators accuracy to prevent HAC penalties.
• Discharge status codes reviewed for transfer payments; physician queries identified as needed.

Conocimientos

IP-DRG auditing

Medical coding

DRG validation

POA accuracy

Query management

Educación

Bachelor’s/Master’s in Life Sciences

CCS or CIC certification

Herramientas

3M 360 Encompass

Epic

Cerner

Optum

Descripción del empleo

**Job Title: Quality Auditor – Inpatient DRG****Experience:** 5–10 years in Medical Coding (minimum 3 years specifically in Inpatient DRG coding/auditing)**1. Job Purpose**The IP-DRG Auditor is responsible for reviewing inpatient medical records to ensure that the assigned ICD-10-CM (Diagnoses) and ICD-10-PCS (Procedures) codes accurately reflect the patient’s clinical stay. The primary goal is to validate the **MS-DRG (Medicare Severity)** or **APR-DRG (All Patient Refined)** assignment to ensure compliance and optimized, legitimate reimbursement.**2. Key Responsibilities****Core Audit Functions:*** **DRG Validation:** Verify that the **Principal Diagnosis** is correctly identified according to the Official Coding Guidelines.* **MCC/CC Verification:** Audit the chart for Major Complications/Comorbidities (MCC) or Complications/Comorbidities (CC) that impact the DRG weight and hospital payment.* **Surgical Review:** Validate **ICD-10-PCS** codes, ensuring that the root operation, approach, and body part are accurately captured from the operative report.* **POA (Present on Admission):** Ensure the accuracy of POA indicators to prevent Hospital-Acquired Condition (HAC) penalties.* **Discharge Status:** Verify discharge status codes (e.g., home, skilled nursing, home health), as these can trigger \"transfer\" payment rules.**CDI & Query Management:*** Identify opportunities for **Physician Queries** where documentation is ambiguous, incomplete, or conflicting.* Collaborate with Clinical Documentation Improvement (CDI) teams to bridge the gap between clinical language and coding requirements.**Feedback & Quality Improvement:*** Perform 100% \"Pre-bill\" audits for high-dollar DRGs or specific focus areas (e.g., Sepsis, Respiratory Failure, Cardiac procedures).* Conduct \"Root Cause Analysis\" (RCA) on DRG shifts and provide educational feedback to the coding team.* Keep the team updated on the **IPPS (Inpatient Prospective Payment System)** annual updates (effective every Oct 1st).**3. Technical Expertise Required*** **Mastery of ICD-10-PCS:** High proficiency in the 7-character grid system for inpatient procedures.* **DRG Logic:** Deep understanding of how \"Grouping\" works (MS-DRG vs. APR-DRG).* **Clinical Knowledge:** Strong understanding of pathophysiology and pharmacology (to recognize when a diagnosis is supported by the treatment/medication administered).* **Systems:** Expertise in **3M 360 Encompass** (the industry standard for DRG), Optum, and EHRs like **Epic** or **Cerner**.**4. Qualifications & Experience****Education:*** Bachelor’s/Master’s in Life Sciences (B.Pharm, Nursing, MBBS, BPT, etc.).**Mandatory Certifications:*** **CCS (Certified Coding Specialist)** - *The most preferred certification for IP coding.** **CIC (Certified Inpatient Coder)** - *Highly valued for BPO/KPO roles.** *(Optional)* **CDIP** or **CCDS** is a major plus if the role involves heavy clinical documentation review.**Work Experience:*** Proven experience in high-acuity facilities (Level 1 Trauma centers or large Teaching Hospitals).* Experience with **Denials Management** (answering DRG-related clinical appeals) is highly desirable.**5. Key Performance Indicators (KPIs)*** **Financial Accuracy:** Ensuring the \"DRG Shift\" rate is within company standards.* **Coding Accuracy:** Maintaining a minimum of **96% - 98% accuracy** in diagnosis and procedure selection.* **Turnaround Time (TAT):** Auditing charts within 24–48 hours to ensure the hospital's \"Days in AR\" (Accounts Receivable) is minimized.* **Query Rate:** Maintaining an appropriate query rate to ensure documentation supports the billed DRG.**PHYSICAL DEMANDS:** **Note:** Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.