Healthcare Auditor III, Skilled Nursing Facility / Resource Utilization Group

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

📋 Description

• In this completely remote role as a Skilled Nursing Facility auditor, you will leverage your clinical expertise to verify the accuracy of billed charges, ensuring the integrity of paid claims through coding validation, payment accuracy, adherence to contractual obligations, and compliance with regulations.

• You will employ industry standards and EXL proprietary tools throughout the review process, while also crafting professional communications to document audit findings and provide supporting justifications.

• Additionally, you will utilize your vast clinical and industry experience to pinpoint audit trends and identify opportunities for improvement.

⛳️ Requirements

• RN/LPN/LVN with an active and current license.

• LPN or Registered Nurse with an Associate's or Bachelor's degree is preferred.

• A minimum of 3 years of experience in skilled nursing, with preference given to candidates holding RAC certification, reimbursement experience, or MDS coordinator knowledge, particularly in PDPM/RUG.

• Prior experience or exposure to RUG and PDPM Medicare reimbursement systems, as well as the Medicaid 48 grouper reimbursement system.

• Familiarity with billing of HIPPS codes and understanding of billing days for each assessment type.

• **Knowledge and Skills:**

• Excellent time management and prioritization abilities.

• Strong written and verbal communication skills, with a keen eye for detail and strong analytical capabilities.

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

• A passion for auditing skilled nursing claims and a commitment to working in an environment that values teamwork, excellence, collaboration, inclusiveness, and support.

• Ability to work independently in a remote setting, achieving outstanding results during EXL core business hours.

• A proactive approach to problem-solving.

🏝️ Benefits

• For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits.