IPDRG Coder / IPDRG- QA

Key Responsibilities:

For IPDRG Coders:

• Code inpatient records (discharge summaries, H&P, operative reports) using ICD-10-CM and PCS codes.
• Assign appropriate MS-DRG or APR-DRG based on principal diagnosis, procedures, CC/MCCs, and POA indicators.
• Ensure compliance with CMS guidelines, hospital-specific protocols, and payer requirements.
• Flag incomplete or ambiguous documentation and initiate physician queries.
• Meet daily productivity and 95%+ accuracy targets.

For IPDRG QA Analysts:

• Audit coded inpatient charts to ensure DRG accuracy and documentation compliance.
• Provide feedback and re-training to coders on audit findings.
• Monitor trends in errors and recommend process or training improvements.
• Collaborate with compliance and clinical documentation teams.
• Maintain audit reports and coding quality dashboards for client and internal use.

Eligibility Criteria:

• Education: Life Science / Paramedical / Nursing graduate
• Certification:
• AAPC or AHIMA certified CPC, CCS, or CIC preferred
• Experience:
• Coders: 2+ years of IP coding with DRG exposure
• QA: 35 years including audit/QC responsibilities in inpatient coding

Key Skills Required:

• Strong understanding of ICD-10-CM, ICD-10-PCS, DRG grouping logic
• Familiarity with Medicare Severity DRG (MS-DRG) and APR-DRG methodologies
• Knowledge of Clinical Documentation Improvement (CDI) practices
• Proficient in encoders (3M, TruCode, Optum) and EHR systems
• Excellent analysis, attention to detail, and written communication (especially for QA)