APDRG Coder

Key Responsibilities

• Review inpatient medical records, discharge summaries, physician notes, and other clinical documentation.
• Analyze principal diagnoses, secondary diagnoses, comorbidities, complications, and relevant procedures to support accurate DRG assignment.
• Assign appropriate ICD-10-CM and ICD-10-PCS codes, as applicable.
• Apply relevant APDRG classification rules and guidelines to determine the appropriate DRG.
• Identify documentation gaps, inconsistencies, and potential coding errors, and seek clarification.
• Ensure coding accuracy, compliance, and adherence to applicable coding standards and organizational policies.
• Review clinical documentation to identify factors that may affect DRG assignment, severity, and reimbursement.
• Meet established productivity, quality, and turnaround-time targets.
• Collaborate with coding auditors, clinical documentation teams, and other healthcare RCM stakeholders to resolve coding-related queries.
• Stay updated on changes to coding guidelines, DRG classification systems, and payer-specific requirements.

Requirements & Tech Stack

• Hands-on experience in inpatient medical coding and DRG classification.
• Strong understanding of APDRG methodology and applicable DRG grouping guidelines.
• Good knowledge of medical terminology, anatomy, physiology, and disease processes.
• Proficiency in interpreting inpatient medical records and discharge summaries.
• Understanding of ICD-10-CM and ICD-10-PCS coding.
• Strong analytical skills and attention to detail.
• Ability to meet quality and productivity targets in a deadline-driven environment.
• Good communication and documentation skills.

Qualifications

• Relevant medical coding certification, such as CCS or an equivalent credential (preferred).
• Experience with inpatient coding audits and DRG validation (preferred).
• Exposure to clinical documentation improvement (CDI) and coding compliance processes (preferred).