IPDRG QAs Raghav IT Solution Services OPC Pvt. Ltd

4.0 - 8.0 years

0 Lacs

chennai, tamil nadu

On-site

The IPDRG QA role involves conducting quality assurance reviews of inpatient medical records to ensure accurate assignment of DRGs, ICD-10-CM/PCS codes, and adherence to coding and clinical documentation standards. This position plays a crucial role in upholding compliance with federal coding guidelines, regulatory mandates, and maintaining revenue cycle integrity. Key responsibilities of the role include conducting retrospective and concurrent quality reviews of inpatient coding and DRG assignments, validating the accuracy and completeness of coding based on clinical documentation, auditing DRG assignments to ensure appropriate severity of illness (SOI), risk of mortality (ROM), and reimbursement, collaborating with coding teams and clinical documentation specialists to address discrepancies, providing feedback and training to coders on errors, trends, and best practices, ensuring compliance with CMS guidelines, AHA Coding Clinic guidance, and facility policies, staying updated on coding changes, DRG grouping logic, and regulatory requirements, utilizing computer-assisted coding (CAC) tools, encoder systems, and EHRs for audits, assisting in developing quality improvement plans based on audit findings, and generating reports and dashboards for leadership on coding accuracy and DRG performance metrics. The qualifications required for this role include holding RHIA, RHIT, CCS, or equivalent AHIMA certification, having a minimum of 3-5 years of inpatient coding and/or DRG auditing experience, possessing in-depth knowledge of ICD-10-CM/PCS, DRG reimbursement methodologies, and CMS regulations, demonstrating strong analytical, problem-solving, and communication skills, and having experience with hospital information systems, EHRs, and CAC tools such as 3M and Optum. This is a full-time position that necessitates a Bachelor's degree. Applicants must have at least 3 years of experience as an IPDRG QA and hold CPC, CCS, or CIC certification. The work location for this role is in Bangalore, Karnataka, and it requires in-person presence. For further details or to discuss the job opportunity, please contact the employer at +91 9570805386.,

Posted 1 week ago

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Quality Assurance - Inpatient Diagnosis Related Groups Jobstronaut

3.0 - 7.0 years

0 Lacs

hyderabad, telangana

On-site

The client, a US HealthCare service provider, is seeking a Quality Assurance - Inpatient Diagnosis Related Groups for their team based in Hyderabad. The ideal candidate should have at least 3+ years of experience in Inpatient DRG QA with expertise in ICD-10-CM/PCS & MS-DRG. Possession of certifications such as CCS, CIC, or CPC is required for this role. Experience in EPIC, Cerner, and 3M encoder is preferred. The candidate should demonstrate a strong understanding of Official Coding.,

Posted 2 weeks ago

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Clinical document specialist / manager Mancer Consulting Services

3.0 - 7.0 years

0 Lacs

hyderabad, telangana

On-site

You will be joining a leading global healthcare organization that is recognized among the Top 100 on the Fortune 500 list and operates in the U.S. and U.K. This organization oversees a network of over 180 hospitals in 26 U.S. states and the U.K., with a workforce of 350,000+ employees worldwide. With a focus on innovation and patient care, the company generates over $65 billion in annual revenue and is currently establishing an HR Shared Services GCC in Hyderabad to enhance its global capabilities. In this role as a Clinical Documentation Improvement Specialist (CDI), your responsibilities will include reviewing clinical documentation in electronic health records to ensure accuracy, completeness, and compliance with coding standards. You will be required to issue compliant queries to physicians and work closely with internal teams to maintain documentation integrity, encompassing leadership, compliance management, quality audits, and training governance. Your duties will involve conducting concurrent reviews of inpatient records using EHR platforms such as Iodine and Epic, identifying documentation gaps, and issuing compliant, patient-specific queries. It will be essential for you to apply your knowledge of DRG classification, ICD-10-CM/PCS, and coding guidelines to effectively carry out your tasks. Additionally, you will be responsible for maintaining accurate logs of reviews, query status, and follow-ups in designated systems, meeting productivity and quality benchmarks set within the CDI program. Furthermore, you will be tasked with managing multiple CDI teams and leads to drive quality, efficiency, and compliance, as well as defining and implementing standardized workflows aligned with enterprise objectives. Collaboration with U.S. and India leadership on training, reporting, and process enhancements will also be a key aspect of your role. This position requires working hours in the U.S. shift to accommodate the demands of the role effectively.,

Posted 1 month ago

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