Skilled Nursing Facilities Auditor III

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $60.1k - $98.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 2%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 clinical reviews to verify the accuracy of skilled nursing facility billing • Apply CMS clinical guidelines and payer-provider contract terms and policies to identify overpayments under PDPM, RUG, and contracted per diem methodologies • Apply ICD-10 coding guidelines to validate diagnoses coded on Minimum Data Set assessments • Document accurate audit results, audit rationales, and supporting findings using EXL tools, CMS guidelines, and payer contractual terms and policies • Use proprietary workflow systems to make audit determinations and move claims through the workflow process • Meet or exceed EXL program productivity and quality goals • Monitor changes and updates to clinical guidelines, reimbursement trends, client processes, and requirements • Comply with EXL policies and procedures, including HIPAA and state and federal regulations • Identify audit trends and opportunities and write professional communications documenting findings

🎯 Requirements

• RN/LPN/LVN with current active license • LPN or Registered Nurse with Associate's or Bachelor's degree preferred • 3+ years of skilled nursing experience • Preference for candidates with RAC certification, reimbursement experience, or MDS coordinator experience 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 billing HIPPS codes and days of billing for each assessment type • Proficiency in Excel, Word, and OneNote with general computer literacy • Ability to work independently in a remote environment during EXL core business hours • Strong time management, work prioritization, written and verbal communication, analytical, and attention-to-detail skills

🏖️ Benefits

• Up to 10% annual travel for team meetings and limited client onsite engagements • More information on benefits and offerings is available at https://www.exlservice.com/us-careers-and-benefits