IPDRG Specialty Auditor (Inpatient DRG)

IPDRG Specialty Auditor

pre-bill and post-bill inpatient DRG audits

accurate DRG assignment, CC/MCC integrity, ICD-10-PCS correctness, and compliance with CMS and official coding guidelines

specialty audit role

• Perform pre-bill and post-bill IPDRG audits
• Validate: Principal Diagnosis (UHDDS) CC/MCC clinical support ICD-10-PCS procedures and root operation selection DRG accuracy and variance impact
• Review inpatient documentation: H&P, Progress Notes, Operative Notes, Discharge Summary
• Ensure compliance with: ICD-10-CM / ICD-10-PCS guidelines Coding Clinic CMS IPPS rules
• Identify audit risks, coding errors, and compliance gaps
• Prepare audit findings with proper guideline references
• Provide audit-based feedback and education to coders
• Support escalation audits, internal audits, and quality improvement initiatives
  

• Inpatient DRG Auditing (MS-DRG / APR-DRG)
• CC/MCC Validation & Clinical Reasoning
• ICD-10-PCS Root Operation & Sequencing Logic
  

• Error trend analysis, RCA / CAPA
• Audit documentation & reporting (Excel)
• Exposure to high-risk DRGs (Cardiac, Ortho, Neuro, OB/Newborn)
• Coder education and feedback handling
  

Education

Certifications

• CCS (AHIMA)
• CIC / CPC
• CPMA (Added advantage)