JOB SUMMARY

We are seeking a highly experienced Senior Inpatient DRG Coding professional with a minimum of 10

years of experience. The ideal candidate should currently be working in a QA, SME, Process Coach, Senior Auditor, or Inpatient DRG Trainer role and demonstrate strong expertise in ICD-10-CM, ICD-10-PCS, MS-DRG, inpatient coding guidelines, clinical documentation, and coding quality. Candidates with hands-on Clinical Documentation Improvement (CDI) experience are strongly preferred, particularly those who can connect clinical documentation, coding accuracy, DRG assignment, and revenue-impacting opportunities.

KEY RESPONSIBILITIES

Perform and/or oversee Inpatient DRG coding and auditing for US healthcare accounts.

Review inpatient medical records for accurate assignment of ICD-10-CM, ICD-10-PCS, MS-DRG/APR-

DRG, POA indicators, CC/MCC, HAC considerations, and discharge disposition.

 Validate principal diagnosis selection and application of Official ICD-10-CM/PCS Coding Guidelines and UHDDS principles.

 Review complex inpatient cases involving sepsis, respiratory failure, AKI, encephalopathy, cardiac conditions, stroke, trauma, infections, surgical cases, complications, and other high-acuity conditions.

 Validate ICD-10-PCS code selection, including root operation, body part, approach, device, qualifier,

and procedure details.

 Analyze DRG shifts, reimbursement-impacting coding errors, missed diagnoses/procedures,

sequencing issues, and documentation-related concerns.

 Identify appropriate CC/MCC capture opportunities based on clinical documentation and applicable coding guidelines.

 Act as a subject matter expert for complex coding cases, escalations, and coding-policy questions.

 Provide coding guidance, mentoring, and process coaching to production coders.

 Develop and deliver training programs for Inpatient DRG coders, including refresher training based on audit findings and recurring error trends.

 Create coding examples, case studies, competency assessments, quizzes, and other training materials.

 Perform root-cause analysis of recurring coding errors and recommend corrective and preventive actions.

 Support implementation of ICD-10-CM/PCS, MS-DRG, client-specific, and payer-related coding updates.

 Participate in coding calibration sessions, quality meetings,



client discussions, and escalation reviews as required.

 Develop and maintain coding guidelines, SOPs, audit checklists, training materials, and process documentation.

 Support new account transitions, process migrations, coding methodology implementations, and continuous improvement initiatives.

 Collaborate with Operations, QA, Training, CDI, and Client Management teams.

REQUIRED QUALIFICATIONS

US HEALTHCARE | MEDICAL CODING

Senior Inpatient DRG Coding SME – QA & Training

 Minimum 10+ years of experience in US Inpatient Medical Coding / DRG coding.

 Current or recent experience in a QA, SME, Process Coach, Senior Auditor, or Inpatient DRG Trainer capacity.

 Expert knowledge of ICD-10-CM and ICD-10-PCS.

 Solid working knowledge of MS-DRG methodology and inpatient reimbursement concepts.

 Strong understanding of Principal Diagnosis, Secondary Diagnoses, CC/MCC, POA, HAC, DRG sequencing, and discharge disposition.

 Hands-on experience reviewing complex inpatient medical records.

 Strong understanding of inpatient surgical and medical procedures.

 Ability to interpret physician documentation, operative reports, discharge summaries, progress notes,

consults, imaging, laboratory results, and other clinical documentation.

 Strong analytical, auditing, communication, coaching, and training skills.

STRONG PREFERENCE – CDI EXPERIENCE

 Candidates with hands-on Clinical Documentation Improvement (CDI) experience are strongly preferred.

 Experience identifying documentation opportunities through clinical indicators and provider documentation.

 Understanding of the relationship between clinical documentation, coding, CC/MCC capture, DRG assignment, and compliant reimbursement.

 Experience collaborating with CDI specialists, physicians/providers, coding teams, and clinical stakeholders.





 Ability to distinguish documentation clarification opportunities from unsupported or non-compliant coding practices.

 Experience with CDI audits, concurrent review, retrospective review, physician queries, or documentation quality initiatives is an advantage.

PREFERRED CERTIFICATIONS

 CCS – Certified Coding Specialist

 CPC – Certified Professional Coder

 CCDS – Certified Clinical Documentation Specialist

 CDIP – Certified Documentation Improvement Practitioner

 Other recognized US healthcare coding, CDI, auditing, or HIM certifications

PREFERRED TECHNICAL & PLATFORM EXPERIENCE

 3M 360 Encompass or other DRG/coding encoder platforms

 Optum / EncoderPro

 TruCode

 Epic, Cerner, Meditech, or other EHR platforms

 Computer-Assisted Coding (CAC) and AI-assisted coding technologies

 Coding analytics, audit, quality-management, and workflow platforms

CORE COMPETENCIES

 Inpatient Medical Coding – Expert

 ICD-10-CM – Expert

 ICD-10-PCS – Expert

 MS-DRG – Expert

 Coding QA / Audit – Expert

US HEALTHCARE | MEDICAL CODING

Senior Inpatient DRG Coding SME – QA & Training

 Clinical Documentation – Advanced

 CDI Concepts – Advanced / Preferred

 Coder Training & Mentoring – Advanced

 Process Coaching – Advanced

 Root-Cause Analysis – Advanced

 Client / Stakeholder Communication – Advanced

WHAT WE ARE LOOKING FOR The ideal candidate is not only an experienced production coder but a senior-level professional who can independently review complex inpatient cases, identify coding and DRG issues, explain the rationale behind the correct coding, coach other coders, and convert audit findings into practical training and process improvements. A strong combination of Inpatient DRG expertise, QA/auditing, SME or process coaching, training, and CDI experience will be highly valued.

WORK ARRANGEMENT

This is a fully remote position. The selected candidate will work remotely and collaborate with coding,

QA, CDI, training, operations, and client-facing teams through approved digital communication and workflow platforms.

EQUAL OPPORTUNITY STATEMENT

We are committed to providing an inclusive and qualified work environment. Employment decisions are

- based on qualifications, experience, skills, and business requirements.

📌 Inpatient (IP) DRG Auditor (India)
🏢 Bulwark Health
📍 India