Diagnosis-Related Group Auditor III, Healthcare

🔥 4 hours ago

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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 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

• Competitive benefits package, including healthcare, vision, dental, and 401(k) options • Hands-on experience with top-tier clients in the healthcare industry • Mentorship and career development programs to help you grow professionally • Strong culture of collaboration, support, and inclusivity