Conducts secondary quality audits of inpatient medical records and DRG assignments. Validates diagnoses, procedures, POA indicators, discharge dispositions, and coding compliance with IPPS, ICD-10-CM/PCS, HIPAA, payer, and client requirements. Identifies error trends, meets quality SLAs, maintains audit trackers, and reports findings using 3M software, NLP tools, and Microsoft Office. Requires certified inpatient coding expertise, strong communication, and adherence to SOPs and project protocols.
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
- 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.
- Follow all project-specific protocols, workflows, and client instructions.
Education - Bachelor’s Degree in Science or Nursing.
Certifications
One or more of the following mandatory certifications:
CCS – Certified Coding Specialist
CIC – Certified Inpatient Coder
CPC – Certified Professional Coder
Experience -
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.
EXL Chennai, Tamil Nadu, IND Office
Chennai, India
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