DRG Auditor I

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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 for accurate DRG assignment and reimbursement • Apply coding guidelines and industry-leading tools to identify overpayments • Prepare clear, concise, and well-supported audit findings using AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations • Use DRG encoder tools such as 3M and Webstrat to improve audit efficiency and accuracy • Meet or exceed quality and productivity standards, including strong appeal uphold rates • Monitor industry trends, coding updates, and compliance regulations

🎯 Requirements

• One or more of the following credentials required: CCS, RHIA, RHIT, CPC • Associate degree or 1 year of experience • Knowledge of coding guidelines • Knowledge of Official Guidelines for Coding and Reporting and Coding Clinic Guidance • Experience with encoder tools such as 3M, Webstrat, or Optum Encoder • Ability to work independently in a remote environment during EXL core business hours • Excellent time management and work prioritization skills • Strong written and verbal communication, analytical skills, and attention to detail • Proficiency in Excel, Word, and OneNote • General computer literacy • Passion for DRG auditing • A brief coding/auditing assessment may be included in the interview process

🏖️ Benefits

• Healthcare, Vision, Dental and 401k options • Mentoring program assigning junior employees a senior professional advisor • Guidance and coaching • Opportunities to work with experienced healthcare consultants • Professional growth and development opportunities • Teamwork and time-management skill development