Senior Executive - Quality Auditor

Job description

**Job Description: 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 - Responsibilities: 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. **Qualifications: 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.