Diagnosis-Related Group Auditor III

🔥 1 hour ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $73k - $98.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 2%

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement • Apply coding guideline expertise and 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 • Use advanced DRG encoder tools such as 3M and Webstrat to improve audit efficiency and accuracy • Meet or exceed EXL quality and productivity standards, including strong uphold rates for appeals • Stay current with industry trends, coding updates, and compliance regulations • Adhere to HIPAA and EXL policies and procedures to ensure data security and regulatory compliance

🎯 Requirements

• Minimum High School Diploma (higher education preferred) • CCS, CIC, CPC, RHIA, or RHIT credential; multiple credentials preferred • 4+ years of MS-DRG/APR-DRG coding experience • Deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies • Prior experience in DRG retrospective overpayment identification auditing highly desirable • Strong proficiency with DRG encoder tools, including 3M and Webstrat • Expert-level inpatient coding knowledge • In-depth understanding of ICD-10-CM/PCS coding guidelines • Ability to work independently in a remote environment • Exceptional time management, problem-solving, and analytical skills • Strong written and verbal communication and attention to detail • Proficiency in Excel, Word, OneNote, and overall computer literacy • Commitment to teamwork, collaboration, and continuous learning • Ability to adhere to HIPAA and EXL policies and procedures • A brief coding/auditing assessment may be included in the interview process

🏖️ Benefits

• Fully remote work experience from a home office • Up to 10% annual travel for team meetings and limited client onsite engagements • Industry-leading training • Career development opportunities • Mentorship and career development programs • Healthcare, vision, and dental benefits • 401(k) options • Collaborative, supportive, and inclusive culture • Hands-on experience with top-tier healthcare clients

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