- 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 Qualified 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.