Senior Executive - Coding Auditor

  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

 

ADDITIONAL AND ESSENTIAL RESPONSIBILITIES: •             Follow every aspect of SOP without fail  •             Complete received Audits with Quality •             To achieve Quality and production target •             Follow project related protocols  and instructions  •             Escalate issues, identify trends... •             Update all the logs like productivity, Clarification log, and any other logs applicable, daily  •             Check with Manager /TL in case of clarifications  •             All emails from Manager should be answered promptly without fail •             Ensure compliance of entire team for HIPAA,OIG •             Good excel skills  •             Flexibility •             Good Communication

Edu. Qualifications: Nursing Mandatory 

Certification - Mandatory CCS - Certified Coding Specialist

 Experience: 3+ Years after CCS certification

 Working Hours: 40 HOURS PER WEEK, FULL-TIME EMPLOYEE

Skills and abilities:

•             Auditing experience on IP DRG.

•             Knowledge in Microsoft outlook/excel/word.

•             Exposure on 3M software and NLP tool.