Executives-Auditors-DRG

  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

 Qualifications: Bachelors in nursing preferable / bachelor’s in science.

Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder

 Experience: Minimum 2 years’ experience in IP DRG coding or auditing.

 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.

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.

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