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Assistant Manager, Inpatient DRG Coding Audits
Assistant Manager role focused on inpatient DRG coding audits at EXL, a data analytics and digital operations company. The position reviews medical records, supports coding teams, and strengthens compliance, data quality, and reimbursement accuracy.
विवरण
- Perform detailed DRG validation audits on selected inpatient medical records
- Examine documentation to confirm diagnoses and procedures are clinically supported and coded at the highest appropriate specificity
- Verify discharge disposition, present-on-admission indicators, and diagnosis sequencing
- Investigate and resolve differences between coded information and clinical documentation
- Conduct secondary reviews of complex or contested coding cases
- Track audit patterns and identify coding or documentation issues that affect data quality and reimbursement
- Work with Compliance teams on audit conclusions and regulatory requirements
- Coach coders and CDI Specialists through targeted feedback
- Create and deliver training covering DRG optimization, clinical indicators, coding standards, and audit outcomes
- Assess regulatory developments and changes to coding guidelines
- Keep audit documentation current and produce periodic reports covering trends, root causes, and recommendations
- Present findings to management and contribute to performance improvement efforts
- Coordinate with CDI teams, physicians, clinical staff, IT, and data analytics teams
- Complete audits accurately while meeting quality and production objectives
- Escalate concerns, analyze recurring trends, and maintain productivity and clarification logs
- Respond promptly to manager correspondence and resolve questions with managers or team leads
आवश्यकताएँ
- Bachelor’s degree in science; a bachelor’s degree in nursing is preferred
- CCS (Certified Coding Specialist) certification is required
- CIC (Certified Inpatient Coder) certification is required
- Experience auditing inpatient DRG coding
- Proficiency with Microsoft Outlook, Excel, and Word
- Experience with 3M software and NLP tools
- Knowledge of the IPPS methodology
- Strong Excel skills
- Ability to work flexibly
- Effective communication skills
- Ability to follow SOPs and project protocols
- Commitment to HIPAA and OIG compliance
लाभ
- Hybrid work arrangement
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