Executives-Auditors-DRG

  Conduct comprehensive reviews of inpatient medical records to validate that assigned ICD-10-CM/PCS codes and DRG classifications accurately reflect the documented clinical conditions and procedures.

  Ensure compliance with IPPS (Inpatient Prospective Payment System) methodology, CMS guidelines, and official coding rules when determining DRG assignment.

  Verify accuracy and specificity of diagnoses, procedures, POA indicators, and discharge disposition, ensuring documentation supports all coding decisions.

  Identify documentation gaps and collaborate with clinical teams to obtain necessary clarifications for accurate code assignment.

  Mentor, coach, and support coding staff, providing guidance on complex DRG and inpatient coding scenarios.

  Deliver feedback and ongoing education to both coders and Clinical Documentation Improvement (CDI) specialists to improve coding quality and documentation completeness.

  Perform routine coding quality audits to assess accuracy, identify trends, and recommend corrective actions.

  Analyze audit findings and prepare detailed reports, highlighting errors, patterns, and opportunities for improvement.

  Stay updated on regulatory changes, payer guidelines, and industry best practices related to IPPS, DRG validation, and inpatient coding.

  Participate in cross-functional meetings with coding, CDI, compliance, and operations teams to strengthen documentation and coding accuracy across the organization