Gopichand Settem
Ipdrg Auditor @AGS Health
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WORK HISTORY
Ipdrg Auditor @AGS Health
Conduct rigorous audits of inpatient records to validate ICD-10-CM/PCS and MS-DRG/APR-DRG accuracy.Verify clinical indicators to ensure CC/MCC captures are supported by provider documentation.Identify coding trends and root causes of discrepancies to mitigate compliance risks and RAC audits.Maintain 95%+ quality standards through detailed reviews of complex surgical and medical cases.Collaborate with CDI teams to bridge gaps between clinical documentation and final code assignment.Generate audit reports providing actionable data to management regarding revenue integrity and accuracy.Educate coding staff by delivering targeted feedback and training on evolving CMS guidelines.Ensure regulatory compliance with UHDDS definitions and Official Coding Guidelines.Optimize reimbursement by ensuring the billed DRG accurately reflects patient severity and resource use.Utilize advanced encoders and EHR systems (e.g, 3M, Epic, Cerner) to streamline the auditing process.
EDUCATION
Loyola College
Bsc, Chemistry
Vellore Institute of Technology
Master's degree, Chemistry
ABOUT GOPICHAND SETTEM
Strategic IP-DRG Auditor focused on the intersection of clinical care and data integrity. Expert in capturing the true Severity of Illness (SOI) and Risk of Mortality (ROM) through meticulous record review and compliant physician collaboration. I am committed to maintaining a 95%+ accuracy rate while driving continuous improvement in Inpatient Clinical Documentation (CDI) standards\"
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