Perform in-depth quality reviews of inpatient medical records to validate DRG coding, POA, procedures, discharge disposition and compliance with IPPS methodology. Mentor and train DRG auditors, provide feedback and education to coding staff, meet quality SLAs, track error trends, follow SOPs, maintain HIPAA compliance, and update monitoring trackers.
JOB DESCRIPTION The DRG Quality Analyst is responsible for performing an in-depth quality review of inpatient medical records to ensure that the DRG Auditor validated the billed diagnoses, POA, procedures, discharge disposition and DRG codes in accordance with the medical record documentation and in compliance with IPPS methodology. Quality Analyst is responsible for mentoring and training the DRG Auditors to reach the quality SLA. Provide ongoing feedback and education to coding staff. ESSENTIAL CRITERIA: Bachelor’s in science/ Bachelor’s in nursing Certified - CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder, CPC - Certified Professional Minimum 5 years’ experience in IP DRG coding or auditing. Minimum 1- 2 years' experience in Quality. DESIRABLE CRITERIA: Auditing experience on IP DRG. Knowledge in Microsoft outlook/excel/word. Exposure on 3M software and NLP tool. 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
About the TeamEXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.
EXL Chennai, Tamil Nadu, IND Office
Chennai, India
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