EXL—Executive-Coding Auditor

Job description

Description:  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 Requirements: Qualifications: Bachelors in nursing preferable / bachelor’s in science. Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder Experience: Minimum 2 years’ experience in IP DRG coding or auditing. Working Hours: 40 HOURS PER WEEK, FULL TIME EMPLOYEE Skills and abilities: • Auditing experience on IP DRG. • Knowledge in Microsoft outlook/excel/word. • Exposure on 3M software and NLP tool. Responsibilities: ADDITIONAL AND ESSENTIAL 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 • Good excel skills • Flexibility • Good Communication