senior manager ipdrg - Coding specialist

1. DRG Management & Optimization

• Lead and manage the IPDRG process for all inpatient cases (medical, surgical, and multidisciplinary).

• Ensure accurate and compliant DRG coding based on ICD-10-CM/PCS and CPT guidelines.

• Monitor and analyze DRG groupings, case-mix index (CMI), and length of stay (LOS) trends.

• Conduct regular DRG audits and implement corrective actions to optimize reimbursement.

2. Cross-Department Coordination

• Emergency Department, Radiology, Surgery

• Coordinate with clinicians to validate principal diagnosis, procedures, and comorbidities impacting DRG assignment.

• Facilitate DRG-related training sessions for clinicians and coders.

3. Revenue Integrity & Compliance

• Work with the billing and finance teams to resolve DRG discrepancies and denials.

• NABH, JCI, NHA, and insurer DRG protocols

• Review high-value and complex cases for potential DRG upcoding or downcoding risks.

4. Data Analysis & Reporting

• Develop and present DRG performance dashboards and analytics reports for management.

• Benchmark hospital DRG and CMI performance against national or peer standards.

• Identify and drive opportunities for DRG-related process improvements.

5. Team Leadership

• Manage a team of DRG coders, analysts, and audit staff.

• Ensure timely and accurate completion of DRG submissions.

• Support recruitment, training, and competency development of team members.