Auditor III, Healthcare – Skilled Nursing Facility / Resource Utilization Group

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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 clinical reviews to verify the accuracy of skilled nursing facility billing. • Apply CMS clinical guidelines and payer-provider contract terms and policies to a variety of claim scenarios to identify overpayments for claims paid under PDPM, RUG, and contracted per diem payment methodologies. • Apply ICD-10 coding guidelines to validate diagnoses coded on Minimum Data Set assessment. • Document accurate audit results in a clear, concise, and effective manner using applicable EXL tools, CMS guidelines, payer contractual terms and policies. • Utilize proprietary workflow systems 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. • Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements. • Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

🎯 Requirements

• RN/LPN/LVN with current active license • LPN, Registered Nurse with Associate's or Bachelor's degree preferred • 3+ years of skilled nursing experience with preference given to candidates with RAC certification, reimbursement or MDS coordinator with knowledge of PDPM/RUG. • Previous experience/exposure to RUG and PDPM Medicare reimbursement systems and the Medicaid 48 grouper reimbursement system • Previous experience/exposure to the billing of HIPPS codes and days of billing for each assessment type. • Possesses excellent time management and work prioritization skills. • 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 auditing skilled nursing claims with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support. • Works independently in a remote environment and delivers exceptional results during EXL core business hours. • Takes ownership of problem solving.

🏖️ Benefits

• For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits