Diagnosis-Related Group Auditor III, Healthcare

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

📋 Description

• Perform thorough MS-DRG and APR-DRG coding evaluations to ensure precision in DRG classification and reimbursement.

• Leverage extensive knowledge of coding standards and employ industry-leading tools to enhance overpayment detection.

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

• Utilize advanced DRG encoding tools (such as 3M, Webstrat) to improve efficiency and accuracy in audits.

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

• Remain informed on industry trends, coding updates, and compliance regulations to uphold expert-level knowledge.

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

⛳️ Requirements

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

• CCS, RHIA, or RHIT certification (Multiple credentials preferred).

• Over 4 years of experience in MS-DRG/APR-DRG coding with a comprehensive grasp of AHA Coding Guidelines and DRG reimbursement methods.

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

• Strong proficiency with DRG encoding tools (3M, Webstrat).

• Expert-level knowledge of inpatient coding with a thorough understanding of ICD-10-CM/PCS coding guidelines.

• Self-driven and capable of working independently in a remote setting while maintaining high performance.

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

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

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

• A passion for DRG auditing and a commitment to teamwork, collaboration, and continuous professional development.

🏝️ Benefits

• Competitive benefits package, including healthcare, vision, dental, and 401(k) options.

• Hands-on experience with premier clients in the healthcare sector.

• Mentorship and career development programs designed to foster your professional growth.

• Strong culture of collaboration, support, and inclusivity.