Lead Analyst

Company: R1 RCM
Location: Chennai / Hyderabad
Experience: 4+ Years in Inpatient Coding / DRG Validation
Certification: CCS or CIC (Mandatory)

About R1 RCM:

R1 RCM is a leading provider of technology-driven revenue cycle management services for healthcare organizations across the United States. With a strong focus on operational excellence, quality, and innovation, R1 partners with hospitals and health systems to optimize financial performance while improving patient and provider experiences.

Position Overview:
We are looking for an experienced Lead Analyst DRG Validation to join our growing team. This is an role focused on ensuring coding accuracy, DRG integrity, and compliance through comprehensive validation and quality review activities. The ideal candidate will possess strong inpatient coding expertise, sound clinical knowledge, and hands-on experience in DRG validation and quality auditing.

Key Responsibilities:

Perform comprehensive DRG validation reviews on inpatient encounters to ensure accurate code assignment and appropriate DRG reimbursement.

• Conduct quality assurance audits of inpatient coding and DRG assignments in accordance with ICD-10-CM/PCS coding guidelines and payer requirements.
• Review clinical documentation to validate diagnoses, procedures, complications/comorbidities (CCs), and major complications/comorbidities (MCCs).
• Identify coding inaccuracies, documentation gaps, and compliance risks that may impact DRG assignment and reimbursement.
• Provide detailed audit findings, recommendations, and educational feedback to coding teams.
• Support quality improvement initiatives by analyzing coding trends, root causes, and recurring opportunities for enhancement.
• Ensure adherence to industry standards, regulatory requirements, and client-specific quality benchmarks.
• Collaborate with internal stakeholders to resolve complex coding and DRG-related queries.
• Maintain established productivity, quality, and turnaround time expectations.
  
  Required Qualifications:
• Minimum 4+ years of experience in Inpatient Coding (IPDRG).
• Strong experience in DRG Validation, Coding Quality Audits, Clinical Validation, or Coding Compliance functions.
• Thorough understanding of ICD-10-CM, ICD-10-PCS, MS-DRG, APR-DRG, CC/MCC capture, and inpatient reimbursement methodologies.
• Ability to interpret complex clinical documentation and apply coding guidelines accurately.
• Strong analytical, communication, and problem-solving skills.

Preferred Certifications :

• CCS (Certified Coding Specialist) / CIC (Certified Inpatient Coder)
  
  Compensation & Benefits:
  
  Compensation: Up to 18 LPA (based on experience and skillset)
  Opportunity to work with one of the leading healthcare revenue cycle organizations supporting major U.S. health systems.
  Exposure to complex inpatient cases and advanced DRG validation processes.
  
  Additional Details:

Work Location: Chennai / Hyderabad
Notice Period: Up to 60 Days
Relieving Letter: Mandatory

Apply Now
Interested candidates can share their updated resumes via Email or WhatsApp.
HR Thushara
9840681675
traju4@r1rcm.com