Auditor Inpatient Coding (DRGV)
Orcapod Consulting Services Private Limited 4.9
General
Work from Office
1
Any
Not Required
No
Job Description
Perform quality audits and validation of inpatient medical coding records, DRG validations (DRGV), and clinical documentation.
Review assigned ICD-10-CM and ICD-10-PCS diagnosis and procedure codes to ensure compliance with official US Healthcare coding guidelines.
Identify coding errors, DRG downgrades/upgrades, and revenue leakages across the Revenue Cycle Management (RCM) pipeline.
Ensure strict adherence to HIPAA guidelines, patient privacy standards, and payer-specific billing rules.
Provide constructive audit feedback and educational recommendations to medical coding and billing teams.
Prepare audit summary reports, error trend analyses, and quality scorecards for operational leadership.
Qualifications
Bachelor’s or Master’s Degree in Life Sciences, Nursing, Pharmacy, Biotechnology, or related healthcare disciplines.
3-5 Yrs of hands-on experience in inpatient medical coding, DRG validation, and RCM auditing within US Healthcare.
Relevant professional coding certification (e.g., CIC, CCS, or CPC) is preferred.
In-depth understanding of MS-DRG/APR-DRG methodologies, ICD-10-CM coding, and US billing compliance.