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.
JOB LOCATION: Chennai
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
