DRG 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 validate accuracy in DRG assignments and reimbursement.

• Utilize extensive knowledge of coding standards and industry-leading tools to enhance identification of overpayments.

• Generate clear, concise, and well-supported audit reports in alignment with AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.

• Employ advanced DRG encoding tools like 3M and Webstrat to boost the efficiency and precision of audits.

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

• Remain informed about industry developments, coding changes, and compliance requirements.

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

⛳️ Requirements

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

• Possession of CCS, CIC, CPC, RHIA, or RHIT credentials.

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

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

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

• Proficient use of DRG encoder tools, particularly 3M and Webstrat.

• Advanced knowledge of inpatient coding practices.

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

• Capability to work independently within a remote setting.

• Exceptional skills in time management, problem-solving, and analysis.

• Strong written and verbal communication abilities with meticulous attention to detail.

• Proficiency in Excel, Word, and OneNote.

• Overall strong computer literacy.

• Dedication to teamwork, collaboration, and ongoing professional development.

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

🏝️ Benefits

• Fully remote work arrangement from a home office.

• Leading training in the industry.

• Opportunities for career advancement.

• Competitive benefits package.

• Healthcare, vision, and dental coverage.

• Options for 401(k) retirement plans.

• Mentorship and career growth programs.

• A collaborative, supportive, and inclusive work culture.

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

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