Hybrid Assistant Manager – Coding Auditors

at EXL

• Job title: Assistant Manager – Coding Auditors
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, India

About the role

• Assistant Manager responsible for coding audits and compliance in healthcare. Ensuring accuracy, mentoring coders, and collaborating with clinical staff in India.

Responsibilities

• **1. 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.
• **2. 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.
• **3. 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.
• Serve as a resource for complex coding questions and provide interpretation of regulatory updates and coding guideline changes.
• **4. Reporting and Documentation**
• Maintain detailed and accurate records of all audit activities and findings.
• Prepare periodic audit reports summarizing trends, root causes, and recommendations for improvement.
• Communicate results to management and participate in performance improvement initiatives.
• **5. Collaboration**
• Work closely with CDI teams, physicians, and other clinical staff to clarify documentation and ensure accurate code assignment.
• Partner with IT and data analytics teams to improve coding and auditing processes.

Requirements

• ** Skills and abilities: **
• **Qualifications: Bachelors in nursing preferable / Bachelor's in science. ******Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder**
• **• Auditing experience on IP DRG.**
• **• Knowledge in Microsoft outlook/excel/word.**
• **• Exposure on 3M software and NLP tool.**

Benefits

• NA