Executive-Coding Auditor

 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
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.
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

Skills
NLP, Excel, Auditing, Documentation

Experience
2+ yrs

Work arrangement
Hybrid