We are seeking a dynamic and seasoned healthcare revenue cycle leader with expertise in IPDRG Payors based in our Chennai office. In this high-impact leadership role, you will spearhead our end-to-end inpatient DRG appeals program, overseeing complex clinical and coding validation denials across multiple payors. You will leverage your deep expertise in IPDRG payor operations, ICD-10-CM/PCS guidelines, and AHA Coding Clinics to optimize reimbursement accuracy, minimize financial leakage, and mentor our high-performing teams.
Key Responsibilities:
- Appeals Leadership: Direct and oversee the end-to-end inpatient DRG appeals program, managing DRG downgrades, clinical validation denials, and coding validation denials from all major payors.
- Clinical & Coding Integrity: Ensure every appeal is backed by precise MS-DRG and APR-DRG assignment, correct principal diagnosis selection, and proper MCC/CC capture in strict alignment with ICD-10-CM/PCS Official Guidelines and Coding Clinic.
- Medical Record Review Oversight:
Direct comprehensive medical record reviews to verify that documentation fully supports billed DRG assignments, and exercise sound judgment on when to accept versus appeal a denial.
- Quality & Analytics: Analyze denial trends, overturn/change rates, and key quality parameters to develop and execute targeted corrective action plans.
- Cross-Border Team Management: Provide operational leadership and guidance to the Manila team during the start of their shift.
Experience and Qualification:
- 15+ years of progressive healthcare experience, with a solid background as a Senior Manager, Associate Director, Deputy Director, or Director working specifically on the IP DRG payor side.
- Mandatory CCS (Certified Coding Specialist) credential from AHIMA.
Key Skills
- Medical Coding
- Analytical and Strategic thinking
- Communication
- Team management
- Stakeholder management
Work type:
- Full-Time
- Work from Office
📌 Assistant Director - IPDRG Payors (Chennai)
🏢 Access Healthcare Services
📍 Chennai
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