Diagnosis-Related Group Auditor III

This is a fully remote position, open to applicants in Florida.

📋 Description

• Perform thorough reviews of MS-DRG and APR-DRG coding to guarantee accuracy in DRG assignment and reimbursement.

• Utilize coding guideline expertise and state-of-the-art tools to enhance the identification of overpayments.

• Develop clear, concise, and well-supported audit findings in accordance with AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.

• Employ advanced DRG encoder tools like 3M and Webstrat to boost audit efficiency and precision.

• Achieve or surpass EXL's quality and productivity benchmarks, including maintaining strong appeal uphold rates.

• Keep abreast of industry trends, coding updates, and compliance regulations.

• Follow HIPAA and EXL policies and procedures to guarantee data security and adherence to regulatory requirements.

⛳️ Requirements

• Minimum of a High School Diploma (higher education is preferred).

• Possession of CCS, CIC, CPC, RHIA, or RHIT credentials; multiple credentials are preferred.

• At least 4 years of experience in MS-DRG/APR-DRG coding.

• Comprehensive understanding of AHA Coding Guidelines and DRG reimbursement methodologies.

• Previous experience in auditing for DRG retrospective overpayment identification is highly desirable.

• Strong proficiency with DRG encoder tools, including 3M and Webstrat.

• Expert-level knowledge in inpatient coding.

• In-depth familiarity with ICD-10-CM/PCS coding guidelines.

• Capacity to work independently in a remote setting.

• Outstanding time management, problem-solving, and analytical abilities.

• Excellent written and verbal communication skills alongside a keen attention to detail.

• Proficient in Excel, Word, OneNote, and overall computer literacy.

• Commitment to teamwork, collaboration, and ongoing learning.

• Ability to comply with HIPAA and EXL policies and procedures.

• A brief coding/auditing assessment may be incorporated into the interview process.

🏝️ Benefits

• Fully remote work opportunity from a home office.

• Up to 10% annual travel for team meetings and limited client onsite engagements.

• Industry-leading training programs.

• Opportunities for career development.

• Access to mentorship and career advancement programs.

• Healthcare, vision, and dental benefits.

• 401(k) options available.

• A collaborative, supportive, and inclusive workplace culture.

• Hands-on experience with premier healthcare clients.