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
- Perform comprehensive secondary quality audits on inpatient medical records reviewed by DRG Auditors.
- Validate accuracy of principal and secondary diagnoses, procedures, POA indicators, discharge disposition, and final DRG assignment.
- Ensure compliance with IPPS regulations, ICD-10-CM/PCS guidelines, official coding conventions, and payer/client-specific requirements.
- Adhere strictly to all Standard Operating Procedures (SOPs) without deviation.
- Ensure 100% compliance with HIPAA and data security standards at all times.
Use quality tools, 3M software, NLP tools, and internal systems effectively for audit and reporting activities. - Demonstrate strong working knowledge of Microsoft Excel, Outlook, and Word for documentation and reporting.
- Follow all project-specific protocols, workflows, and client instructions.
Education - Bachelor’s Degree in Science or Nursing.
Certifications
One or more of the following mandatory certifications:
CCS – Certified Coding Specialist
CIC – Certified Inpatient Coder
CPC – Certified Professional Coder
Experience -
Minimum 5 years of experience in Inpatient DRG coding or auditing.
Minimum 1–2 years of experience in a Quality Analyst or Quality Auditing role.
Preferred Qualifications (Desirable Criteria)
Prior experience conducting IP DRG quality audits.
Hands-on exposure to 3M encoder software and NLP tools.
Strong proficiency in Microsoft Excel, including trackers, analysis, and reporting.
Experience working in SLA-driven, high-compliance healthcare environments.
Skills Required
- Bachelor's Degree in Science or Nursing
- CCS - Certified Coding Specialist
- CIC - Certified Inpatient Coder
- CPC - Certified Professional Coder
- Minimum 5 years experience in Inpatient DRG coding or auditing
- Minimum 1-2 years experience in a Quality Analyst or Quality Auditing role
- Strong working knowledge of IPPS regulations, ICD-10-CM/PCS guidelines, and official coding conventions
- Ensure 100% compliance with HIPAA and data security standards
- Strong Microsoft Excel skills (trackers, analysis, reporting)
- Excellent verbal and written communication
- Familiarity with quality tools and internal audit/reporting systems
- Prior experience conducting IP DRG quality audits
- Hands-on exposure to 3M encoder software and NLP tools
- Experience working in SLA-driven, high-compliance healthcare environments
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.
