Senior Executive - Coding Auditor

Job Description

 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.