Assistant Director - IPDRG Payors
Access Healthcare Services- Posted 3 hours ago
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Job Description
JOB SUMMARY
We are seeking a dynamic and seasoned healthcare revenue cycle leader with expertise in IPDRG Payors based in our Chennai office. In this high-impact leadership role, you will spearhead our end-to-end inpatient DRG appeals program, overseeing complex clinical and coding validation denials across multiple payors. You will leverage your deep expertise in IPDRG payor operations, ICD-10-CM/PCS guidelines, and AHA Coding Clinics to optimize reimbursement accuracy, minimize financial leakage, and mentor our high-performing teams.
Key Responsibilities:
Appeals Leadership: Direct and oversee the end-to-end inpatient DRG appeals program, managing DRG downgrades, clinical validation denials, and coding validation denials from all major payors.
Clinical & Coding Integrity: Ensure every appeal is backed by precise MS-DRG and APR-DRG assignment, correct principal diagnosis selection, and proper MCC/CC capture in strict alignment with ICD-10-CM/PCS Official Guidelines and Coding Clinic.
Medical Record Review Oversight: Direct comprehensive medical record reviews to verify that documentation fully supports billed DRG assignments, and exercise sound judgment on when to accept versus appeal a denial.
Quality & Analytics: Analyze denial trends, overturn/change rates, and key quality parameters to develop and execute targeted corrective action plans.
Cross-Border Team Management: Provide operational leadership and guidance to the Manila team during the start of their shift.
Experience and Qualification:
15+ years of progressive healthcare experience, with a strong background as a Senior Manager, Associate Director, Deputy Director, or Director working specifically on the IP DRG payor side.
Mandatory CCS (Certified Coding Specialist) credential from AHIMA.
Key Skills
Medical Coding
Analytical and Strategic thinking
Communication
Team management
Stakeholder management
Work type:
Full-Time
Work from Office
More Info
Key Skills
About Company
The transformative DNA of innovationInnovation runs through Access Healthcare's organizational DNA, a legacy established at our founding in 1998. We have consistently evolved to address the increasingly complex demands of the healthcare industry. Our pioneering approach-integrating proprietary technology with exceptional talent-has established us as a global leader in technology-enabled revenue cycle management (RCM).Our strategic approachGuided by a commitment to continuous improvement, Access Healthcare leverages AI-driven automation, proprietary workflows, and deep healthcare expertise to deliver efficient, scalable RCM solutions. We empower healthcare organizations to optimize financial performance, streamline operations, and enhance patient care delivery.Beyond service: a strategic partnershipMore than a service provider, Access Healthcare serves as a trusted strategic partner in healthcare. By helping providers navigate complex reimbursement systems and achieve financial sustainability, we enable healthcare organizations to concentrate on their primary mission: delivering exceptional patient care.Growth strategyOur recent strategic investment from New Mountain Capital accelerates our mission of transforming revenue management for healthcare providers. This partnership enhances our capacity to scale, develop next-generation technologies, and expand into emerging markets-all while maintaining our core principles of innovation and operational excellence.Our team of over 30,000+ revenue cycle professionals helps our clients redefine their revenue cycle and achieve superior administrative, financial, and clinical outcomes. We work with our clients to provide unmatched global delivery cost structures, market-leading automation solutions, and consistent quality.Scalability. Automation. Transparency.Our revenue cycle services operating model:Delivers superior business outcomes by applying our unique best practice combination of people, process, technology, and analyticsUtilizes technology to enable business efficiency and effectivenessApply workflow, knowledge management, and employee productivity improvement tools (arc.in)Automate processes with our purpose-built, proprietary robotic process automation, and analytics platform, echo Deploys top-notch people (recruiting, training, and retaining the right people, at scale)Quick FactsCreated in 2011 by leaders of Vision Healthsource (acquired by Dell Services), a leader in providing revenue cycle servicesPrivately held. Investors include former executives at Dell Services (Perot Systems) and Ross Perot Jr.Leaders with experience in building multiple large-scale business process services operations serving hundreds of healthcare organizations20 global delivery centers in 9 cities in India, the Philippines, and the USADeveloped and launched echo - The industry's first Intelligent Revenue Cycle Process Automation platformSupport 500,000+ physicians and process over 400 million transactions per yearCoverage of 80+ specialtiesManage $120+ billion in claims annuallyDeep experience with all billing platforms and payersWorld-class service level guaranteesLatest News and updates