EXL—Senior Executive - Quality Auditor

Job description

Description: ADDITIONAL AND ESSENTIAL RESPONSIBILITIES: - Follow every aspect of SOP without fail. - Complete received Audits for quality review and ensure quality output. - To achieve Quality SLA and quality production target. - Excellent verbal and written communication. - Follow project related protocols and instructions. - Escalate issues, identify error trends. - Update all the required monitoring trackers. - All emails from Leads/Manager should be answered promptly without fail. - Ensure to adhere with HIPAA compliance. - Good excel skills. - Flexibility - Good Communication Requirements: Education - Bachelor’s Degree in Science or Nursing. Certifications One or more of the following mandatory certifications: CCS – Certified Coding Specialist CIC – Certified Inpatient Coder CPC – Certified Professional Coder Experience - Minimum 5 years of experience in Inpatient DRG coding or auditing. Minimum 1–2 years of experience in a Quality Analyst or Quality Auditing role. Preferred Qualifications (Desirable Criteria) Prior experience conducting IP DRG quality audits. Hands-on exposure to 3M encoder software and NLP tools. Strong proficiency in Microsoft Excel, including trackers, analysis, and reporting. Experience working in SLA-driven, high-compliance healthcare environments. Responsibilities: - Perform comprehensive secondary quality audits on inpatient medical records reviewed by DRG Auditors. - Validate accuracy of principal and secondary diagnoses, procedures, POA indicators, discharge disposition, and final DRG assignment. - Ensure compliance with IPPS regulations, ICD-10-CM/PCS guidelines, official coding conventions, and payer/client-specific requirements. - Adhere strictly to all Standard Operating Procedures (SOPs) without deviation. - Ensure 100% compliance with HIPAA and data security standards at all times. Use quality tools, 3M software, NLP tools, and internal systems effectively for audit and reporting activities. - Demonstrate strong working knowledge of Microsoft Excel, Outlook, and Word for documentation and reporting. - Follow all project-specific protocols, workflows, and client instructions.