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Deschide
EXL este o companie de consultanță și servicii pentru afaceri care ajută organizațiile să utilizeze datele, analizele și tehnologia pentru a-și îmbunătăți operațiunile și a lua decizii mai bune. Activitatea sa include managementul operațiunilor, analiza decizională și transformarea digitală, având experiență în sprijinirea clienților din domeniul sănătății, al asigurărilor, al finanțelor și al logisticii. EXL combină știința datelor cu expertiza practică în afaceri pentru a dezvolta soluții adaptate obiectivelor, modelului operațional și contextului sectorial al fiecărei organizații.
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.
Descriere
- 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
Cerințe
- 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
Beneficii
- Hybrid work arrangement
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