DRG Appeals Auditor

About the Role

We are seeking highly motivated MBBS, MD graduates with strong clinical knowledge to join our DRG Coding and Appeals team as an Appeal Writer. The role involves reviewing inpatient medical records, understanding clinical documentation, analyzing payer denials, and drafting evidence-based appeal letters to support appropriate DRG assignments and reimbursement. This is an excellent opportunity for fresh medical graduates looking to build a career in the US Healthcare Revenue Cycle Management (RCM), Clinical Documentation Improvement (CDI), and DRG validation domain.

Key Responsibilities

• Review inpatient medical records, discharge summaries, operative notes, laboratory results, and physician documentation.
• Analyze DRG downgrades, coding denials, and clinical validation denials.
• Prepare clear, concise, and evidence-based appeal letters using clinical findings and supporting documentation.
• Interpret disease processes, treatments, diagnostic findings, and procedures to support appeal rationale.
• Research payer denial reasons and assist in preparing appropriate rebuttals.
• Collaborate with coding specialists, auditors, CDI teams, and physicians to gather necessary clinical evidence.
• Ensure compliance with ICD-10, DRG guidelines, CMS regulations, and payer-specific policies.
• Maintain productivity and quality standards established by the organization.
• Participate in training programs related to DRG coding, medical coding, and denial management.

Requirements & Tech Stack

• MBBS, MD (Mandatory)
• MS Office applications

Qualifications

• Education: MBBS, MD (Mandatory)
• Experience: No prior experience required. Clinical internship experience will be an added advantage.
• Skills:
• Clinical Knowledge: Strong understanding of human anatomy, physiology, pathology, pharmacology, and disease processes. Ability to interpret medical records, diagnostic reports, and physician documentation. Good clinical reasoning and analytical skills.
• Communication Skills: Excellent written and verbal communication. Strong medical writing and documentation skills. Ability to present clinical arguments logically and effectively.
• Analytical Skills: Attention to detail and accuracy. Ability to analyze complex clinical scenarios and identify relevant supporting evidence. Problem-solving mindset and willingness to learn.
• Basic knowledge of US healthcare systems, medical coding, or DRG concepts is preferred but not mandatory.

Preferred Candidate Profile

• MBBS/MD graduate seeking a non-clinical career in healthcare.
• Strong academic background and clinical aptitude.
• Interest in medical coding, DRG validation, CDI, payer denials, and revenue cycle management.
• Quick learner with a passion for healthcare analytics and documentation review.

Career Growth Opportunities

The role provides exposure to:

• DRG Coding and Validation
• Clinical Documentation Improvement (CDI)
• Denial Management and Appeals
• Medical Coding Audits
• Revenue Integrity
• US Healthcare Reimbursement Systems