Diagnosis-Related Group Auditor III

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

📋 Description

• Perform thorough reviews of MS-DRG and APR-DRG coding to ensure precise DRG assignments and reimbursement accuracy.

• Leverage extensive knowledge of coding guidelines and tools to enhance the identification of overpayments.

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

• Utilize advanced DRG encoder tools, such as 3M and Webstrat, to boost audit efficiency and precision.

• Achieve or surpass EXL quality and productivity benchmarks, including maintaining strong uphold rates for appeals.

• Remain informed about industry trends, coding updates, and compliance regulations.

• Comply with HIPAA and EXL policies and procedures to ensure data security and adherence to regulatory standards.

⛳️ Requirements

• At least a High School Diploma (higher education preferred).

• CCS, CIC, CPC, RHIA, or RHIT credentials (multiple credentials preferred).

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

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

• Prior experience in auditing for DRG retrospective overpayment identification is highly preferred.

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

• Advanced knowledge of inpatient coding.

• Thorough understanding of ICD-10-CM/PCS coding guidelines.

• Capability to work independently in a remote setting.

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

• Strong written and verbal communication skills with a keen attention to detail.

• Proficiency in Excel, Word, and OneNote.

• High level of overall computer literacy.

• Dedication to teamwork, collaboration, and ongoing learning.

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

🏝️ Benefits

• Fully remote work experience from a home office.

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

• Industry-leading training opportunities.

• Career development prospects.

• Competitive benefits package.

• Healthcare, vision, and dental benefits.

• 401(k) options available.

• Mentorship and career development programs.

• Fast-paced, innovative environment with industry-leading experts.

• Hands-on experience with top-tier healthcare clients.

• Culture focused on collaboration, support, and inclusivity.