Quality Auditor-IPDRG

Description

We are seeking a Quality Auditor-IPDRG to join our team in India. The successful candidate will be responsible for conducting audits of IPDRG documentation to ensure compliance with healthcare regulations and standards. This role requires a keen eye for detail and a strong understanding of healthcare coding and quality assurance processes.

Role: Senior IPDRG /Quality Auditor

Location: Hyderabad, Chennai, Noida

Associate – IPDRG (Medical Coding)

Job Category: Medical & Clinical Operations

Location: Hyderabad, Chennai, Noida

Experience : 6-12 years

Role Overview

We are looking for experienced IPDRG Medical Coders with strong expertise in Inpatient Coding and DRG Assignment. The ideal candidate should possess a solid understanding of ICD-10-CM, ICD-10-PCS, and MS-DRG methodologies, along with the ability to maintain high standards of coding accuracy, quality, and productivity.

CPC Certification is Mandatory.

Primary Responsibilities

•                    Review and assign accurate medical codes for inpatient records in accordance with coding guidelines and client requirements.

•                    Perform IPDRG coding and ensure accurate DRG assignment based on clinical documentation.

•                    Maintain productivity, quality, and turnaround time (TAT) targets.

•                    Apply knowledge of medical terminology, anatomy, physiology, pathophysiology, and disease processes in coding decisions.

•                    Ensure compliance with coding regulations, payer guidelines, and organizational policies.

•                    Participate in coding audits and implement feedback to improve coding accuracy and quality.

•                    Stay updated with ICD-10-CM, ICD-10-PCS, MS-DRG guidelines, reimbursement methodologies, and regulatory changes.

•                    Collaborate with quality analysts, trainers, and operations teams to achieve departmental goals.

•                    Identify and escalate coding-related issues as needed.

•                    Maintain confidentiality and security of patient health information.

Required Qualifications

Educational Qualification:

•                    Graduate or Postgraduate in:

·               Life Sciences

·               Pharmacy (B.Pharm / M.Pharm)

·               Nursing

·               Physiotherapy (BPT / MPT)

·               BHMS

·               BAMS

·               Dental Sciences (BDS / MDS)

·               Allied Health Sciences

Certification:

✅ CPC (AAPC) Certification – Mandatory

Required Experience

•                    Minimum 6+ years of hands-on experience in IPDRG Coding.

•                    Strong experience in Inpatient Medical Coding and DRG Assignment.

Good understanding of:

·               ICD-10-CM

·               ICD-10-PCS

·               MS-DRG Methodology

•                    Experience in US Healthcare coding processes.

•                    Exposure to quality and productivity-driven coding environments.

Required Skills

• Strong knowledge of medical terminology, anatomy, physiology, and disease processes.
• Excellent understanding of inpatient coding guidelines and DRG concepts.
• Strong analytical and problem-solving abilities.
• Good written and verbal communication skills.
• Attention to detail with a focus on coding quality and accuracy.
• Ability to work effectively in a team-oriented environment.
• Ability to adapt quickly to changing business and client requirements.