Senior Executive

Location

Chennai | India

Job description

DRG QA Auditor:

A DRG Quality Auditor performs QC reviews of the internal audit team's DRG validation coding. They check the medical records and/or other documentation to ensure the DRG/coding assignment is correct and complete based on the clinical evidence, review methodologies, and contract specifications. They document and report the review results, provide clinical/policy/regulatory justification for the determination, and give feedback to the auditors in a polite and helpful way. They are familiar with ICD-10-CM & PCS coding guidelines and AHA Coding Clinics and CMS IPPS rules and regulations and have proficiency in both MS and APR DRG methodology preferred.

Job Duties and Responsibilities

The Quality Control Auditor will review previously audited claims for any missed opportunities or errors.

• The Quality Control Clinical Auditor will review all opportunities sent to the customers for complete and correct information.
• The Quality Control Clinical Auditor will check for physician's notes supporting the DRGs assigned.
• Reviewing medical records to determine accuracy of billing through verification of coding and supporting clinical documentation.
• Reviewing previously conducted audits to ensure accurate coding and identifying potential savings.
• Demonstrated expert knowledge of, ICD-10-CM codes, PCS and DRG coding, understanding of payer rules and regulations, including Medicare and Medicaid with the ability to work independently with minimal supervision and demonstrate initiative.

Job tags

Salary