oracle
Assistant Manager - Coding Auditors
EXL
Chennai, IND
Hybrid
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AM DRG coding Auditor is responsible for performing an in-depth review of select inpatient medical records to ensure that the assigned codes and DRG are supported by clinical documentation and all diagnoses and procedures are coded with the required specificity and the discharge disposition and the POA are correct Knowledge of IPPS methodology is required. Responsible for mentoring and training other coders. Provide ongoing feedback and education to coding staff and Clinical Documentation Specialists.
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Coding Audit And Review
Conduct detailed DRG validation audits on selected inpatient medical records to ensure coding accuracy, completeness, and compliance with ICD-10-CM/PCS, AHA Coding Clinic, and CMS guidelines.
Review documentation to confirm that all reported diagnoses and procedures are supported and coded to the highest level of specificity.
Validate the assignment of the discharge disposition, Present on Admission (POA) indicators, and sequencing of diagnoses.
Identify and correct discrepancies between coded data and clinical documentation.
Perform secondary reviews as needed for complex or disputed coding cases.
Compliance And Quality Assurance
Ensure adherence to all official coding guidelines, facility policies, and payer-specific rules.
Monitor and analyze audit trends to identify coding or documentation issues impacting data quality and reimbursement.
Collaborate with the Compliance Department to address audit findings and ensure regulatory adherence.
Education And Mentoring
Provide ongoing feedback and coaching to coders and Clinical Documentation Improvement (CDI) Specialists to enhance coding accuracy and documentation quality.
Develop and deliver targeted training sessions on DRG optimization, clinical indicators, coding guidelines, and audit findings.
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