DRG Auditor

August 21

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EXL

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

10,000+ employees

💰 $2M Venture Round on 2015-01

📋 Description

• Remote - Home Office opportunity for the right candidate. • In this fully remote position as a Home Health Auditor, you will apply your expert clinical knowledge in the auditing of Home Health medical records to validate or revise the Provider's billed services. You will utilize industry and EXL proprietary tools in the Home Health review process and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive clinical and industry knowledge to identify audit trends. • Conduct Home Health reviews to verify the accuracy of the billed services based on CMS guidelines. • Apply CMS guidelines during medical record review to ensure services provided are supported; maximize overpayment identifications. • Document audit results in clear, concise, and effective manner using CMS Home Health, Oasis and ICD-10 CM Guidelines. • Utilize proprietary workflow systems and encoder tools (e.g., Decision Health, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly. • Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals. • Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

🎯 Requirements

• Extensive knowledge of PDGM and PPS payment methodologies. • Experience with encoder tools (Decision Health, ICD-10, Webstrat). • Works independently in a remote environment and delivers exceptional results during EXL core business hours. • Possesses excellent time management and work prioritization skills. • Takes ownership of problem solving. • Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail. • Proficient in Excel, Word, and OneNote with general computer literacy. • Passionate about Home Health Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support. • LPN, Registered Nurse with Associate's or Bachelor's degree preferred • 3+ years of acute care nursing experience with preference given to candidates with OASIS or Coding Certification. • Prior Home Health auditing experience.