Executive-Coding Auditor

Job description

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 **Responsibilities: 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: 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.**