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
* 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
* • Positive excel s
📌 Executive - Coding Auditor (Chennai)
🏢 EXL
📍 Chennai