DRG Auditor III, Healthcare

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

📋 Description

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

• Leverage extensive knowledge of coding regulations and employ top-tier tools to enhance identification of overpayments.

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

• Utilize sophisticated DRG encoder tools (like 3M and Webstrat) to improve efficiency and precision in audits.

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

• Stay informed on industry trends, coding modifications, and compliance standards to sustain expert-level proficiency.

• Comply with HIPAA and EXL policies and procedures to guarantee data security and adherence to regulations.

⛳️ Requirements

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

• Credentials such as CCS, RHIA, or RHIT (having multiple credentials is preferred).

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

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

• Strong expertise with DRG encoder tools (3M, Webstrat).

• In-depth knowledge of inpatient coding with a comprehensive understanding of ICD-10-CM/PCS coding guidelines.

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

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

• Strong written and verbal communication skills with a keen eye for detail.

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

• Enthusiasm for DRG auditing and a dedication to teamwork, collaboration, and ongoing learning.

🏝️ Benefits

• Healthcare

• Vision

• Dental

• 401(k)

• Mentorship and career development programs

• A strong culture of collaboration, support, and inclusivity