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.