Job Description – Subject Matter Expert (SME) – IPDRG Medical Coding

Job Title: Subject Matter Expert (SME) – IPDRG

Function: Medical Coding / Clinical Operations

Locations: Chennai / Hyderabad / Noida

Experience: 6+ Years

Qualification: Any Graduation / Any Educational Background

Specialty: Inpatient DRG (IPDRG) Medical Coding & Auditing

Employment Type: Full-Time

Role Overview

We are looking for an experienced Subject Matter Expert (SME) – IPDRG Medical Coding with mandatory hands-on experience in IPDRG / Inpatient Medical Coding.

The ideal candidate should have strong expertise in IPDRG Coding, Inpatient Coding, DRG Validation, ICD-10-CM, ICD-10-PCS, Medical Coding Audits, Clinical Documentation Review, Coding Quality, Error Analysis, and Coder Education.

Educational background is flexible; however, robust and relevant IPDRG experience is mandatory for this role.

The SME will be responsible for auditing inpatient medical records, validating DRG assignments, identifying coding and documentation discrepancies, providing feedback to coders, analyzing error trends, conducting training sessions, and participating in/leading calibration discussions.

Key Responsibilities

IPDRG Coding & Auditing

· Audit coded Inpatient / IPDRG medical records for accuracy, completeness, and compliance.

· Review and validate ICD-10-CM and ICD-10-PCS codes.

· Validate DRG / MS-DRG assignments based on clinical documentation.

· Review Principal Diagnosis, Secondary Diagnoses, Procedures, CC/MCC, and other relevant clinical information.

· Identify incorrect coding, missed codes, sequencing issues, documentation gaps, and DRG discrepancies.

· Ensure coding accuracy and adherence to applicable coding guidelines.

· Meet defined quality, productivity, and turnaround-time requirements.

DRG & Clinical Validation

· Perform detailed IPDRG / DRG Validation.

· Validate diagnoses and procedures against supporting clinical documentation.





· Identify coding discrepancies that could impact DRG assignment, reimbursement, severity, or coding accuracy.

· Apply strong knowledge of Medical Terminology, Anatomy, Physiology, Pathophysiology, Diagnoses, Procedures, Medications, and Dosages.

· Identify inconsistencies or inaccuracies in medical records and appropriately query/escalate them.

Coding Quality & Compliance

· Ensure adherence to ICD-10-CM, ICD-10-PCS, Official Coding Guidelines, HIPAA, and applicable coding standards.

· Identify coding quality gaps and recommend corrective actions.

· Escalate significant coding, compliance, or quality concerns.

· Maintain confidentiality and accuracy while handling medical information.

· Review coder rebuttals objectively and provide appropriate coding rationale.

Coder Feedback & Training

· Provide clear and detailed feedback to coders on identified errors.

· Differentiate appropriately between coding errors and educational feedback.

· Educate coders on coding updates, guidelines, and complex IPDRG scenarios.

· Conduct knowledge-sharing and training sessions based on recurring coding issues.

· Support coders in improving overall coding quality and accuracy.

Error Trend Analysis & Calibration

· Analyze audit findings and identify recurring coding error trends.

· Prepare and communicate error trend reports.

· Conduct targeted training based on identified quality gaps.

· Participate in and lead calibration sessions involving SMEs, Auditors, Trainers, and Coding teams.

· Ensure consistency in interpretation and application of coding guidelines.





· Support standardization and continuous improvement across the coding process.

SME Responsibilities

· Act as the Subject Matter Expert for IPDRG / Inpatient Coding.

· Provide guidance on complex inpatient coding scenarios.

· Resolve coding-related queries and escalations.

· Stay updated on changes to ICD-10-CM, ICD-10-PCS, DRG / MS-DRG methodologies, and coding guidelines.

· Communicate coding updates and best practices to the team.

· Support quality improvement, training, and capability-development initiatives.

Mandatory Skills

· IPDRG / Inpatient DRG – Mandatory

· IPDRG Medical Coding

· Inpatient Medical Coding

· IPDRG Auditing / Inpatient Coding Audit

· DRG / MS-DRG Validation

· ICD-10-CM

· ICD-10-PCS

· CC / MCC

· Principal & Secondary Diagnosis

· Procedure Coding

· Medical Coding Auditing

· Clinical Documentation Review

· Medical Record Review

· Coding Quality Assurance

· Error Trend Analysis

· Coder Feedback & Training

· Calibration Sessions

· Medical Terminology

· Anatomy & Physiology

· Pathophysiology

· HIPAA Compliance

Certification

Medical Coding Certification from AAPC / AHIMA, such as CPC, CCS, CPC-H/COC, CCS-P, or equivalent, is preferred.

Eligibility

· Any Graduation / Educational Background can be considered.

· 6+ years of relevant experience.

· Strong hands-on IPDRG / Inpatient Medical Coding experience is MANDATORY.

· Candidates should have strong knowledge of ICD-10-CM, ICD-10-PCS, DRG/MS-DRG, CC/MCC, and inpatient coding guidelines.

· Experience in IPDRG Auditing, Quality, SME, Training, or Coding Validation will be highly preferred.

· Strong verbal and written English communication skills.

· Ability to provide detailed coding feedback and conduct knowledge/training sessions.

· Experience participating in or leading coding calibration discussions is preferred.

📌 IPDRG-Medical Coding (Hyderabad)
🏢 Vdart Software Services Private
📍 Hyderabad