EXL is hiring IPDRG - Quality Auditor EXL

2.0 - 7.0 years

2 - 7 Lacs

Hyderabad, Telangana, India

On-site

Bachelors in science/ bachelors in nursing Certified -CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder, CPC - Certified Professional Minimum 5 years experience in IP DRG coding or auditing. Minimum 1 - 2 years experience in Quality. DESIRABLE CRITERIA: Auditing experience on IP DRG. Knowledge in Microsoft outlook/excel/word. Exposure on 3M software and NLP tool. ADDITIONAL AND ESSENTIAL RESPONSIBILITIES: Follow every aspect of SOP without fail. Complete received Audits for quality review and ensure quality output. To achieve Quality SLA and quality production target. Excellent verbal and written communication. Follow project related protocols and instructions. Escalate issues, identify error trends. Update all the required monitoring trackers. All emails from Leads/Manager should be answered promptly without fail. Ensure to adhere with HIPAA compliance. Good excel skills. Flexibility Good Communication

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EXL is hiring IPDRG -Manager EXL

10.0 - 15.0 years

10 - 15 Lacs

Hyderabad, Telangana, India

On-site

Certifications: CPC - Certified Professional CCS - Certified Coding Specialist CIC - Certified Inpatient Coder Experience: Manager: 10 to 15 years experience in medical coding, auditing and automation. Skills and Abilities: Advanced knowledge of medical coding software platforms (e.g., 3M Code Finder, Optum360, True Code, Epic, Cerner, etc.). Minimum 5 years of experience in Inpatient DRG coding. Outpatient medical coding experience is added advantage. Mandatory working experience on US healthcare automation projects. Knowledge on automation tools Knowledge of programming language would be added advantage alike. Python SQL R, etc. Payer experience is added advantage. Expertise in Microsoft outlook/excel/word/Power BI. Primary Roles and Responsibilities: Automation of DRG Coding to streamline repetitive coding tasks. Bringing AI based solutions for DRG claims validations. Improve compliance through predictive analytics. AI-Assisted decision-making automations for diagnosis and procedure codes. Ability to work with physicians, IT professionals, SMEs, and medical coders. Solutions to automatically recognize and extract data from medical records to facilitate auditing. Workflows Optimization. Conducting UAT and providing feedback to the respective teams. Retraining and evaluating the performance of the automated model. Estimating or projecting the return on investment (ROI). Perform analysis of benchmarking. Additional Roles and Responsibilities: Oversee operations of healthcare facilities. Manage staffing, scheduling, and resource allocation Stay updated on changes in healthcare. Develop and implement quality improvement initiatives. Strategic planning process to align organizational goals. Engage in market analysis to understand the competitive landscape. Maintaining SOP and Audit manual. Track key performance indicators (KPIs).

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