Senior Executive - Quality Auditor

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.