Auditor III - SNF/RUG

August 7

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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

• Conduct in-depth clinical reviews to verify skilled nursing facility (SNF) billing accuracy. • Analyze claims paid under PDPM, RUG, and per diem payment models to identify overpayments. • Apply ICD-10 coding guidelines to validate diagnoses on Minimum Data Set (MDS) assessments. • Document audit findings clearly and concisely using EXL tools, CMS guidelines, and payer policies. • Stay up to date on changes in clinical guidelines, reimbursement trends, and regulations. • Meet or exceed productivity and quality goals in a remote, independent work environment.

🎯 Requirements

• Required: • LPN or RN (Associate’s or Bachelor’s degree preferred). • 3+ years of skilled nursing experience (RAC certification, reimbursement, or MDS coordinator experience a plus!). • Familiarity with PDPM, RUG, Medicaid 48 grouper reimbursement, and HIPPS codes billing. • Skills That Set You Apart: • Strong analytical and problem-solving skills. • Excellent written and verbal communication. • Effective time management and ability to prioritize work. • Proficiency in Excel, Word, and OneNote. • A collaborative, team-oriented mindset with the ability to work independently.

🏖️ Benefits

• Remote Opportunity – Work from Home!