Performs secondary quality audits of inpatient medical records and DRG coding, validating diagnoses, procedures, POA indicators, discharge disposition, and final DRG assignments. Ensures compliance with IPPS, ICD-10-CM/PCS, HIPAA, OIG, SOPs, and client requirements. Reviews quality trends, maintains productivity and clarification logs, escalates issues, supports team compliance, and prepares audit reports using 3M software, NLP tools, and Microsoft Office.
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ADDITIONAL AND ESSENTIAL RESPONSIBILITIES:
- Follow every aspect of SOP without fail.
- Complete received Audits for quality review and ensure quality output.
- To achieve Quality SLA and quality production target.
- Excellent verbal and written communication.
- Follow project related protocols and instructions.
- Escalate issues, identify error trends.
- Update all the required monitoring trackers.
- All emails from Leads/Manager should be answered promptly without fail.
- Ensure to adhere with HIPAA compliance.
- Good excel skills.
- Flexibility
- Good Communication
Responsibilities and Essential Functions:
- Perform comprehensive secondary quality audits on inpatient medical records reviewed by DRG Auditors.
- Validate accuracy of principal and secondary diagnoses, procedures, POA indicators, discharge disposition, and final DRG assignment.
- Ensure compliance with IPPS regulations, ICD-10-CM/PCS guidelines, official coding conventions, and payer/client-specific requirements.
- Adhere strictly to all Standard Operating Procedures (SOPs) without deviation.
- Ensure 100% compliance with HIPAA and data security standards at all times.
Use quality tools, 3M software, NLP tools, and internal systems effectively for audit and reporting activities. - Demonstrate strong working knowledge of Microsoft Excel, Outlook, and Word for documentation and reporting.
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Follow all project-specific protocols, workflows, and client instructions.
- QC check
- 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 on a daily basis.
- Check with Manager /TL in case of clarifications
- All emails from Manager should be answered promptly without fail
- Problem solving skill sets
- Ensure compliance of entire team for HIPAA,OIG
Qualifications:
- Education - Bachelor’s Degree in Science or Nursing.
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CPC/CPMA; Min. 3+ Years experience After Certification
- 4 years to 12 years’ experience in medical coding IVR and General surgery
- Working in Quality team is an added advantage.
- Minimum 5 years of experience in Inpatient DRG coding or auditing.
- Minimum 1–2 years of experience in a Quality Analyst or Quality Auditing role.
- Preferred Qualifications (Desirable Criteria)
- Prior experience conducting IP DRG quality audits.
- Hands-on exposure to 3M encoder software and NLP tools.
- Strong proficiency in Microsoft Excel, including trackers, analysis, and reporting.
- Experience working in SLA-driven, high-compliance healthcare environments.
Communication: Strong written (documentation) and oral communication skills
Working Hours:
- 40 hours per week as Full-time employee
- Shift time: 08:00AM TO 05:00PM IST
- Weekends Off
Telecommuter/Internet requirements, if applicable:
- High Speed internet connection at home, must be broadband
- Must understand and adhere with telecommuter policy
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.
EXL Chennai, Tamil Nadu, IND Office
Chennai, India
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