Skilled Nursing Facilities Auditor III

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

📋 Description

• Perform clinical evaluations to ensure the precision of billing for skilled nursing facilities.

• Utilize CMS clinical guidelines along with payer-provider contract terms and policies to detect overpayments under PDPM, RUG, and contracted per diem methodologies.

• Implement ICD-10 coding standards to verify the accuracy of diagnoses recorded on Minimum Data Set assessments.

• Accurately document audit findings, rationales, and supporting evidence using EXL tools, CMS guidelines, and payer contractual terms and policies.

• Leverage proprietary workflow systems to make audit decisions and facilitate claims through the workflow process.

• Achieve or surpass the productivity and quality targets set by the EXL program.

• Keep abreast of modifications and updates to clinical guidelines, reimbursement trends, client processes, and requirements.

• Adhere to EXL policies and procedures, including HIPAA and applicable state and federal regulations.

• Recognize audit trends and opportunities, composing professional communications to document findings.

⛳️ Requirements

• Active RN/LPN/LVN license is required.

• Preference for candidates with an Associate's or Bachelor's degree in nursing.

• A minimum of 3 years of experience in skilled nursing is essential.

• Candidates with RAC certification, reimbursement experience, or MDS coordinator experience with knowledge of PDPM/RUG are preferred.

• Familiarity with RUG and PDPM Medicare reimbursement systems and the Medicaid 48 grouper reimbursement system is advantageous.

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

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

• Must be capable of working independently in a remote setting during EXL's core business hours.

• Strong skills in time management, work prioritization, written and verbal communication, analytical thinking, and attention to detail are required.

🏝️ Benefits

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

• More information on benefits and offerings is available at https://www.exlservice.com/us-careers-and-benefits.