About this role
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.