Quality Auditor - DRGV & IP Coding

Position Name: Quality Auditor - DRGV & IP Coding

Experience: 3 - 5 years

About Us

Ensemble Health Partners - The single solution for a frictionless revenue cycle. We were founded in 2014 with the purpose of redefining the possible in healthcare by empowering people to be the difference. Since then, we’ve grown to support revenue cycle excellence for hundreds of hospitals.

From talent to technology, we at Ensemble provide a single-solution healthcare to industry leaders, enabling them to reach peak RCM performance persistently.

Ensemble Health Partners, India — the company’s Global Capability Center with its flagship facility in Hyderabad serves as a hub for certified professionals managing revenue cycle functions for Ensemble.

Position Summary

Advanced quality auditor position that is responsible for continued training, education and ongoing action plans to ensure quality is consistently met for existing teams. Performs Quality reviews across multiple clients, working in a variety of host systems. Perform account level review to ensure consistency with best practices including but not limited to Quality.

Job Responsibilities

• Review medical record documentation and coding information to evaluate accuracy in code assignment for inpatient DRG cases.
• Review accuracy in assignment of ICD-10-CM, ICD-10-PCS, Principal Diagnosis, Secondary diagnoses codes and provide feedback based on the outcomes.
• Review and identify proper assignment of CC/MCC conditions, POA indicators, HAC/PSI conditions, application of Coding Clinic Updates.
• Audit pre-coded encounters to ensure correct coding assigned, identify areas of improvement and report findings for further education and corrective actions.
• Review inpatient documentation and raise physician queries as needed for missing/incomplete documentation.
• Meet productivity and quality goals consistently in line with organizational policies.

Required Skills

Review pre-coded information based on medical record documentation focused on Inpatient DRG coding and DRG Validation including but not limited to ICD-10-CM, ICD-10-PCS, MS-DRGs, APR-DRGs, CC/MCC, POA, HAC/PSI, Coding Clinic Updates, physician query process.

• Provide advanced guidance on inpatient DRG coding guidelines, coding clinic updates, and physician query process.
• Should be a subject‑matter expert (SME) for complex cases both Medical and Surgical inpatient cases.
• Providing subject matter support to the coding specialists and DRG validators in analysing and resolving coding-related concepts.

In-depth understanding of Inpatient Prospective Payment System including but not limited to MS-DRGs, APR-DRGs, SOI, ROM, Case Mix Index, Revenue impact, and reimbursement methodologies.

Graduate in any discipline (B.Sc./M.Sc. Nursing, B. Pharm, M. Pharm, or Life Sciences education is preferred).