Senior Manager - IPDRG Coding

Access Healthcare; Chennai; On-site; INR 1,500,000 - 2,700,000; Full time

Job summary

Access Healthcare in Chennai seeks a Senior Manager/Associate Director/Deputy Director/Director with IP DRG payor experience to lead end-to-end inpatient DRG appeals programs. You will ensure accurate MS-DRG/APR-DRG assignments, MCC/CC capture, and thorough documentation reviews.

Responsibilities include reviewing medical records, analyzing denial reasons, and implementing corrective actions. You will manage a Manila team at shift start and work from the Chennai office with AHIMA CCS credential.

Qualifications

• Senior leadership roles in IP DRG payor environment.
• Experience handling multiple payors and writing IP DRG appeal letters.
• Strong knowledge of ICD-10-CM Official Guidelines for Coding and Reporting, AHA Coding Clinics, and other regulatory guidelines.
• Lead end-to-end inpatient DRG appeals program covering DRG downgrades, clinical validation denials, and coding validation denials.
• Ensure appeals have accurate MS-DRG and APR-DRG assignment, correct principal diagnosis, and MCC/CC capture.

Responsibilities

• Review medical records to confirm documentation supports the billed DRG and decide when a denial should be accepted rather than appealed.
• Analyze denial reasons and quality metrics; implement corrective action plans.
• Manage Manila team during the beginning of their shift.
• Collaborate with Chennai office to ensure smooth operations.

Skills

IP DRG appeals

MS-DRG/APR-DRG

ICD-10-CM guidelines

AHA Coding Clinics

Regulatory guidelines

Team leadership

Denials analysis

Documentation review

AHIMA CCS

Job description

1. Senior Manager/Associate Director/Deputy Director/ Director who 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.