Senior Executive - Quality Auditor

Job details

Job Description: ADDITIONAL AND ESSENTIAL RESPONSIBILITIES:

Responsibilities: 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.

Qualifications: 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.