DRG Auditor III, Healthcare

🕒 4 days ago

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

💰 $2M Venture Round on 2015-01

Choosing a digital partner is about more than capabilities — it’s about collaboration and character.

📋 Description

• Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement. • Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. • Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. • Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. • Meet or exceed EXL’s quality and productivity standards, including strong uphold rates for appeals. • Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. • Adhere to HIPAA and EXL policies and procedures to ensure data security and regulatory compliance.

🎯 Requirements

• Minimum High School Diploma (Higher education preferred). • CCS, RHIA, or RHIT credential (Multiple credentials preferred). • 4+ years of MS-DRG/APR-DRG coding experience with a deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies. • Prior experience in DRG retrospective overpayment identification auditing is highly desirable. • Strong proficiency with DRG encoder tools (3M, Webstrat). • Expert-level inpatient coding knowledge with an in-depth understanding of ICD-10-CM/PCS coding guidelines. • Self-motivated and able to work independently in a remote environment while maintaining high performance. • Exceptional time management, problem-solving, and analytical skills. • Strong written and verbal communication with attention to detail. • Proficient in Excel, Word, and OneNote, with strong overall computer literacy. • Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.

🏖️ Benefits

• Health insurance • Vision insurance • Dental insurance • 401(k) options • Professional development opportunities • Flexible work arrangements