Manager / Assistant Manager (IP DRG Coding)

Inpatient (DRG) Offshore Coding Manager / Assistant Manager

Position Summary

The Inpatient Offshore Coding Manager is responsible for the operations, quality, productivity, compliance, and performance of the offshore inpatient coding team. This role ensures accurate, complete, and timely coding of inpatient medical records in accordance with ICD-10-CM/PCS Official Guidelines, UHDDS requirements, CMS regulations, client-specific guidelines, and organizational policies.

The manager acts as the primary liaison between offshore coding operations and U.S.-based leadership, auditing, CDI, quality, and client teams. This position requires strong inpatient coding expertise, leadership skills, effective communication, and the ability to identify coding, documentation, compliance, and reimbursement risks.

Essential Duties and Responsibilities

Coding Operations & Team Management

Manage the daily operations of the offshore inpatient coding team, including coders, team leads, and other assigned coding personnel.

Monitor daily coding volumes, productivity, turnaround time, quality, and unbilled account inventories.

Assign and adjust coding workloads according to volume, coder competency, facility requirements, and priority.

Ensure the team consistently meets established productivity and quality standards.

Monitor staffing levels, attendance, scheduling, and coverage to meet contractual service-level requirements.

Conduct routine team meetings, individual coaching sessions, and performance reviews.

Develop corrective actions and performance improvement plans as needed.

Promptly escalate operational, quality, compliance, or staffing concerns to senior leadership.

Inpatient Coding Quality & Compliance

Provide expert oversight of ICD-10-CM and ICD-10-PCS coding, MS-DRG assignment, POA indicators, discharge disposition, and other inpatient coding requirements.

Ensure coding practices comply with:

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ICD-10-CM Official Guidelines for Coding and Reporting

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ICD-10-PCS Official Guidelines for Coding and Reporting

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UHDDS definitions and reporting requirements

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CMS inpatient coding and reimbursement requirements

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AHA Coding Clinic guidance

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AHIMA Standards of Ethical Coding

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Client-specific coding policies and directives

Review complex coding cases and provide guidance on principal diagnosis selection, secondary diagnoses, procedures, sequencing, and DRG assignment.

Identify trends in CC/MCC capture, surgical procedures, spinal fusions, sepsis, respiratory failure, malnutrition, encephalopathy, acute kidney injury, and other diagnoses that may present coding or clinical validation risks.

Ensure diagnoses meet applicable additional diagnosis reporting requirements before code assignment.

Monitor coding practices for inappropriate assumptions, unsupported code assignments, or reliance on documentation that does not meet reporting requirements.

Coordinate with auditing and CDI teams when documentation or coding issues require clarification.Query Management

Ensure coding queries are compliant, non-leading, clinically appropriate, and consistent with organizational and client query policies.

Monitor outstanding physician queries and accounts held for query responses.

Ensure coders adhere to established procedures for unanswered queries and account finalization.

Monitor query trends and identify opportunities for coder and provider education.

Ensure diagnoses requiring clarification or validation are not reported until documentation requirements are met.

Auditing & Quality Assurance

Monitor coder accuracy through routine internal audits and quality reviews.

Review external, client, pre-bill, post-bill, and payer audit findings.

Analyze coding errors, DRG changes, and recurring quality issues.

Develop targeted education and corrective action based on audit findings.

Facilitate coder rebuttals when audit findings require additional review.

Track individual and team accuracy rates and implement improvement plans when performance does not meet expectations.

Collaborate with U.S.-based auditors and coding leadership to maintain consistent interpretation of coding guidelines.

Denial & Risk Management

Monitor coding-related denials and DRG downgrades to identify recurring vulnerabilities.

Review high-risk coding patterns that may increase exposure to payer audits, RAC reviews, clinical-validation denials, or reimbursement recoupments.

Distinguish between coding validation and clinical validation concerns and escalate cases appropriately.

Use denial and audit findings to develop preventive education for coders.

Communicate significant compliance or reimbursement risks to U.S.-based leadership.

Client Management & Communication

Serve as a primary operational contact between offshore coding teams and U.S.-based coding leadership.

Participate in client meetings, operational reviews, audit discussions, and quality meetings as required.

Provide accurate reports on productivity, quality, staffing, backlog, queries, and coding concerns.

Communicate, document, implement, and monitor client-specific coding instructions.

Maintain professional communication across time zones and cultural environments.

Escalate conflicting client directives, regulatory concerns, or potential compliance risks to appropriate leadership.

Minimum Requirements

Education: Associate degree in Health Information Management, Health Information Technology, or a related healthcare field is preferred. A bachelor's degree in HIM, healthcare administration, business administration, or a related discipline is strongly preferred for management-level positions.

Professional Certification: At least one nationally recognized inpatient coding credential is required, preferably CCS (Certified Coding Specialist) through AHIMA. RHIA, RHIT, CDIP, CCDS, CPC, CIC, or other relevant credentials may be considered based on the position's responsibilities.

Experience: Minimum of 7 years of recent inpatient acute-care hospital coding experience, including at least 45 years in coding leadership, supervision, auditing, education, or management. Experience managing offshore or remote coding teams is strongly preferred.

Candidates should demonstrate significant experience with complex inpatient cases, MS-DRG reimbursement, ICD-10-PCS procedures, CC/MCC assignment, POA reporting, coding queries, coding audits, and payer or client coding requirements.

Required Knowledge and Skills

Candidates must demonstrate advanced knowledge of ICD-10-CM/PCS, MS-DRGs, UHDDS reporting requirements, Official Coding Guidelines, AHA Coding Clinic guidance, CMS requirements, and inpatient reimbursement methodology

Strong knowledge of inpatient coding for complex surgical and medical cases is required, including principal diagnosis selection, secondary diagnosis reporting, spinal procedures, device assignment, extensive OR procedures, sepsis, respiratory failure, encephalopathy, malnutrition, acute kidney injury, and other high-risk diagnoses.

The manager must interpret audit findings, identify coding trends, educate staff, resolve coding disagreements, and clearly explain coding rationale using authoritative guidance.

Strong leadership, analytical, organizational, written communication, and interpersonal skills are essential.

Technology Requirements

Experience with major encoder, CAC, EHR, and coding workflow platforms is preferred, including Epic, 3M/360 Encompass, Optum, Cerner/Oracle Health, or similar applications.

Candidates should also demonstrate proficiency with Microsoft Excel, Teams, Outlook, and productivity and quality reporting tools.

Offshore Management Expectations

As this position manages offshore operations supporting U.S. healthcare organizations, the manager must have a strong understanding of U.S. inpatient coding and reimbursement requirements.

The position may require working hours that substantially overlap with U.S. business hours for leadership meetings, client communication, escalation management, and audit discussions.

The manager must maintain strict confidentiality and ensure compliance with HIPAA, organizational information security requirements, client confidentiality standards, and applicable offshore workforce security policies.

Key Performance Indicators

Performance may be measured using:

Inpatient coding accuracy

DRG accuracy

Productivity and records coded per day

Coding turnaround time

DNFB/unbilled account management

Query volume and aging

Audit error trends

Client audit performance

Coding-related denial and downgrade trends

Employee attendance and staffing coverage

Education completion

Corrective action effectiveness

Client satisfaction and SLA performance

Preferred Candidate Profile

The ideal candidate is an experienced inpatient coding leader with strong technical coding knowledge and operational management skills. The candidate should be comfortable challenging unsupported coding decisions, identifying compliance and reimbursement risks, coaching experienced coders, interpreting complex coding guidance, and communicating effectively with U.S.-based clients and leadership.

The successful candidate will focus on coding accuracy, compliance, defensible code assignment, timely account completion, staff development, and consistent application of client and regulatory requirements.