IT Staff Auditor responsible for evaluating IT systems and controls in a nationwide bank. Collaborating with leadership to manage technology risks and compliance.
About the role
- Assistant Manager responsible for coding audits and compliance in healthcare. Ensuring accuracy, mentoring coders, and collaborating with clinical staff in India.
Responsibilities
- **1. Coding Audit and Review**
- Conduct detailed DRG validation audits on selected inpatient medical records to ensure coding accuracy, completeness, and compliance with ICD-10-CM/PCS, AHA Coding Clinic, and CMS guidelines.
- Review documentation to confirm that all reported diagnoses and procedures are supported and coded to the highest level of specificity.
- Validate the assignment of the discharge disposition, Present on Admission (POA) indicators, and sequencing of diagnoses.
- Identify and correct discrepancies between coded data and clinical documentation.
- Perform secondary reviews as needed for complex or disputed coding cases.
- **2. Compliance and Quality Assurance**
- Ensure adherence to all official coding guidelines, facility policies, and payer-specific rules.
- Monitor and analyze audit trends to identify coding or documentation issues impacting data quality and reimbursement.
- Collaborate with the Compliance Department to address audit findings and ensure regulatory adherence.
- **3. Education and Mentoring**
- Provide ongoing feedback and coaching to coders and Clinical Documentation Improvement (CDI) Specialists to enhance coding accuracy and documentation quality.
- Develop and deliver targeted training sessions on DRG optimization, clinical indicators, coding guidelines, and audit findings.
- Serve as a resource for complex coding questions and provide interpretation of regulatory updates and coding guideline changes.
- **4. Reporting and Documentation**
- Maintain detailed and accurate records of all audit activities and findings.
- Prepare periodic audit reports summarizing trends, root causes, and recommendations for improvement.
- Communicate results to management and participate in performance improvement initiatives.
- **5. Collaboration**
- Work closely with CDI teams, physicians, and other clinical staff to clarify documentation and ensure accurate code assignment.
- Partner with IT and data analytics teams to improve coding and auditing processes.
Requirements
- ** Skills and abilities: **
- **Qualifications: Bachelors in nursing preferable / Bachelor's in science. ******Certification- Mandatory CCS - Certified Coding Specialist, CIC - Certified Inpatient Coder**
- **• Auditing experience on IP DRG.**
- **• Knowledge in Microsoft outlook/excel/word.**
- **• Exposure on 3M software and NLP tool.**
Benefits
- NA
Job title
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