Diagnosis Related Group (DRG) Readmission Auditor

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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 readmission 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. • 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. • Stay ahead of industry trends, coding updates, and compliance regulations.

🎯 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. • Prior experience in DRG readmission 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. • 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 readmission auditing and a commitment to teamwork, collaboration, and continuous learning.

🏖️ Benefits

• A fast-paced, innovative environment with a team of industry-leading experts. • Hands-on experience with top-tier clients in the healthcare industry. • Mentorship and career development programs. • A strong culture of collaboration, support, and inclusivity. • Competitive benefits package, including healthcare, vision, dental, and 401(k) options.