Role: IP / DRG / CDI Specialist

Experience: 410 Years
Location: Chennai
Employment Type: Full time/Permanent

Role Overview

We are looking for an experienced IP / DRG / CDI professional with strong expertise in inpatient medical coding, DRG assignment/validation, and clinical documentation improvement. The ideal candidate should be able to analyze complex inpatient cases, identify documentation gaps, validate coding accuracy, and ensure appropriate clinical representation and reimbursement.

Key Responsibilities

- Perform end-to-end inpatient (IP) coding for complex medical and surgical cases.
- Review clinical documentation, medical records, diagnoses, procedures, and treatment details for coding accuracy.
- Assign and validate ICD-10-CM / ICD-10-PCS codes and appropriate MS-DRG/APR-DRG classifications, as applicable.
- Conduct DRG validation and reconciliation to identify coding discrepancies, clinical inconsistencies, and potential revenue-impacting issues.
- Review cases for CC/MCC, complications, comorbidities, principal diagnosis, and secondary diagnosis accuracy.
- Identify Clinical Documentation Improvement (CDI) opportunities by detecting missing, unclear, conflicting, or clinically unsupported documentation.
- Collaborate with physicians, CDI teams, coding teams, auditors, and clinical stakeholders to obtain appropriate clarification through compliant queries.
- Ensure documentation accurately reflects the patient's severity of illness, risk of mortality, clinical complexity, and resource utilization.




- Perform pre-bill/post-bill reviews, coding audits, DRG audits, and quality checks as required.
- Research and interpret official coding guidelines, Coding Clinic guidance, payer requirements, and DRG methodology.
- Maintain high standards of coding accuracy, compliance, productivity, and quality.
- Identify recurring documentation/coding trends and contribute to process improvement and training initiatives.
- Handle complex and high-value inpatient cases independently with minimal supervision.

Mandatory Skills

- Strong experience in Inpatient (IP) Coding
- Hands-on experience with DRG assignment / DRG validation
- Strong understanding of CDI concepts and clinical documentation
- Proficiency in ICD-10-CM and ICD-10-PCS
- Good understanding of Principal Diagnosis, Secondary Diagnosis, CC/MCC, POA, complications and comorbidities
- Experience reviewing complex inpatient charts
- Strong knowledge of official coding guidelines and compliance requirements
- Ability to identify documentation gaps and formulate compliant physician queries
- Strong analytical and clinical documentation review skills

Preferred Qualifications

- CCS / CPC / CIC / CCDS / CDIP or equivalent certification
- Experience with MS-DRG / APR-DRG
- Experience in DRG auditing, validation, or reimbursement optimization
- Exposure to US healthcare / hospital revenue cycle processes
- Experience with EHR/EMR and coding platforms
- Strong knowledge of medical terminology, anatomy, physiology, and disease processes

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