Medical Coders – IPDRG

Key Responsibilities

IP-DRG Coding & Documentation Review

• Review inpatient medical records including admission notes, history & physicals, progress notes, discharge summaries, operative reports, and physician documentation.

• Assign and sequence ICD-10-CM and ICD-10-PCS codes in compliance with IP-DRG and U.S. coding guidelines.

• Accurately identify Principal Diagnosis, Secondary Diagnoses (CC/MCC), Principal Procedure, and Other Procedures.

• Ensure correct DRG assignment based on documented clinical conditions and procedures.

• Validate documentation supports coded diagnoses and procedures for appropriate reimbursement.

Quality & Accuracy

• Maintain productivity and quality benchmarks (target accuracy ≥ 95%).

• Participate in internal audits, peer reviews, and DRG validation checks.

• Analyze coding errors, implement corrective actions, and apply feedback to reduce denials and DRG downgrades.

• Support denial management and clinical validation initiatives.

Compliance & Regulatory Standards

• Ensure adherence to CMS, Medicare, MS-DRG, and payer-specific inpatient coding rules.

• Maintain strict HIPAA compliance and protect PHI.

• Follow internal SOPs, coding standards, and compliance policies.

Collaboration & Communication

• Work closely with QA teams, auditors, CDI specialists, team leads, and operations managers to resolve DRG-related issues.

• Communicate with clinical and CDI teams to clarify documentation impacting severity of illness (SOI) and risk of mortality (ROM).

• Participate in team meetings, training sessions, and continuous improvement initiatives.

Continuous Learning

• Stay current with ICD-10-CM/PCS updates, MS-DRG changes, Coding Clinic guidance, and CMS regulations.

• Participate in ongoing training and professional development programs.

Qualifications & Skills

Education

• Bachelor’s degree in Life Sciences, Nursing, Pharmacy, or a related field (preferred).

Experience

• Minimum 1 year of hands-on experience in IP-DRG / Inpatient Coding.

• Proven experience coding acute care inpatient charts.

• Strong exposure to MS-DRG reimbursement methodology.

Certifications (Mandatory)

• Active coding certification is required.

• Accepted certifications include:

  • CCS (Mandatory / Strongly Preferred)

  • CPC (with proven IP-DRG experience)

• Candidates without certification are not eligible.

Skills

• Strong expertise in ICD-10-CM and ICD-10-PCS.

• Solid understanding of DRG logic, CC/MCC capture, SOI/ROM, and inpatient guidelines.

• Excellent attention to detail and analytical skills.

• Ability to work under productivity and quality targets.

• Strong written and verbal communication skills.

• Ability to follow SOPs and adapt to internal workflows.