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.
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.
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.
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.
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.
Qualifications: Bachelors in nursing preferable / Bachelor's in science.
Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.
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. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.
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Unrealistic overhauls and off-the-shelf products ignore what matters most — your unique needs, culture, goals, and your legacy data and technology environments.
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For more information, visit www.exlservice.com.
