Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures.
Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines, and official coding rules when determining DRG assignment.
Verify accuracy and specificity of diagnoses, procedures, POA indicators, and discharge disposition, ensuring documentation supports all coding decisions.
Identify documentation gaps and collaborate with clinical teams to obtain necessary clarifications for accurate code assignment.
Mentor, coach, and support coding staff, providing guidance on complex DRG and inpatient coding scenarios.
Deliver feedback and ongoing education to both coders and Clinical Documentation Improvement (CDI) specialists to improve coding quality and documentation completeness.
Perform routine coding quality audits to assess accuracy, identify trends, and recommend corrective actions.
Analyze audit findings and prepare detailed reports, highlighting errors, patterns, and opportunities for improvement.
Stay updated on regulatory changes, payer guidelines, and industry best practices related to IPPS, DRG validation, and inpatient coding.
Participate in cross-functional meetings with coding, CDI, compliance, and operations teams to strengthen documentation and coding accuracy across the organization
Responsibilities
ADDITIONAL AND ESSENTIAL RESPONSIBILITIES:
• Follow every aspect of SOP without fail
• Complete received Audits with Quality
• To achieve Quality and production target
• Follow project related protocols and instructions
• Escalate issues, identify trends...
• Update all the logs like productivity, Clarification log, and any other logs applicable, daily
• Check with Manager /TL in case of clarifications
• All emails from Manager should be answered promptly without fail
• Ensure compliance of entire team for HIPAA,OIG
• Good excel skills
• Flexibility
• Good Communication
QualificationsQualifications: Bachelors in nursing preferable / bachelor’s in science.
Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder
Experience: 3+ years of experience after CCS certification
Working Hours: 40 HOURS PER WEEK, FULL-TIME EMPLOYEE
Skills and abilities:
• Auditing experience on IP DRG.
• Knowledge in Microsoft outlook/excel/word.
• Exposure on 3M software and NLP tool.
About UsSkills Required
- CCS (Certified Coding Specialist) certification
- CIC (Certified Inpatient Coder) certification
- 3+ years of coding/auditing experience after CCS certification
- Auditing experience on IP DRG and DRG validation
- Knowledge of ICD-10-CM and ICD-10-PCS coding systems and IPPS methodology
- Knowledge of Microsoft Outlook, Excel, and Word
- Exposure to 3M coding software and NLP tools
- Bachelor's degree (Bachelors in nursing preferable or Bachelor's in science)
- Knowledge of HIPAA and OIG compliance requirements
- Strong communication, mentoring, and coaching skills
What We Do
Choosing a digital partner is about more than capabilities — it’s about collaboration and character. Unrealistic overhauls and off-the-shelf products ignore what matters most — your unique needs, culture, goals, and your legacy data and technology environments. At EXL, our collaboration is built on ongoing listening and learning to adapt our methodologies. We’re your business evolution partner—tailoring solutions that make the most of data to make better business decisions and drive more intelligence into your increasingly digital operations. Whether your goals are scaling the use of AI and digital, redesign operating models, or driving better and faster decisions, we’re here to partner with you to help you gain—and maintain—competitive advantage with efficient, sustainable models at scale. Our expertise in transformation, data science, and change management helps make your business more efficient and effective, improve customer relationships and enhance revenue growth. Instead of focusing on multi-year, resource- and time-intensive platform designs or migrations, we look deeper at your entire value chain to integrate strategies with impact. We use our specialization in analytics, digital interventions, and operations management—alongside deep industry expertise — to deliver solutions that help you outperform the competition. At EXL, it’s all about outcomes—your outcomes—and delivering success on your terms. Share your goals with us and together, we’ll optimize how you leverage data to drive your business forward. For more information, visit www.exlservice.com.
