Quality Auditor ensuring compliance with industry regulations at Solventum, a healthcare company. Assessing suppliers and maintaining quality standards for better healthcare products.
About the role
- DRG coding Auditor conducting reviews of inpatient medical records for coding accuracy. Ensuring compliance with IPPS methodology and providing guidance to coding staff.
Responsibilities
- Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures.
- Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines, and official coding rules when determining DRG assignment.
- Verify accuracy and specificity of diagnoses, procedures, POA indicators, and discharge disposition, ensuring documentation supports all coding decisions.
- Identify documentation gaps and collaborate with clinical teams to obtain necessary clarifications for accurate code assignment.
- Mentor, coach, and support coding staff, providing guidance on complex DRG and inpatient coding scenarios.
- Deliver feedback and ongoing education to both coders and Clinical Documentation Improvement (CDI) specialists to improve coding quality and documentation completeness.
- Perform routine coding quality audits to assess accuracy, identify trends, and recommend corrective actions.
- Analyze audit findings and prepare detailed reports, highlighting errors, patterns, and opportunities for improvement.
- Stay updated on regulatory changes, payer guidelines, and industry best practices related to IPPS, DRG validation, and inpatient coding.
- Participate in cross-functional meetings with coding, CDI, compliance, and operations teams to strengthen documentation and coding accuracy across the organization
Requirements
- Qualifications: Bachelors in nursing preferable / bachelor’s in science.
- Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder
- Experience: Minimum 2 years’ experience in IP DRG coding or auditing.
- Working Hours: 40 HOURS PER WEEK, FULL TIME EMPLOYEE
- Skills and abilities:
- Auditing experience on IP DRG.
- Knowledge in Microsoft outlook/excel/word.
- Exposure on 3M software and NLP tool.
Benefits
- EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates.
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