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.