Auditor III - DRG

EXL was founded on the core values of innovation, collaboration, excellence, integrity, and respect. We are looking for a DRG Auditor III to work 100% remotely from home!

Do you have mastery level experience as a DRG Auditor looking for the next step in your career path?  Is it time for a change?  Explore this opportunity with a new, exciting, and dynamic growth-oriented team.

In this fully remote position as a DRG Auditor you will apply your expert knowledge of DRG coding and reimbursement, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient medical records to validate or revise the provider's billed DRG code. You will utilize industry and EXL proprietary tools in the DRG assignment process and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive coding and industry knowledge to identify audit trends and identify referrals for Clinical Validation review.  Mastery level understanding of MS-DRG and APR-DRG reimbursement, along with staying current with CMS changes related to IPPS. 

Job Responsibilities:

• Conduct MS-DRG and/or APR-DRG coding reviews to verify the accuracy of the DRG assignment and reimbursement.
• Apply coding guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications.
• Document audit results in a clear, concise, and effective manner using appropriate AHA Coding Clinic Guidelines and ICD-10-CM/PCS coding rules and guidelines.
• Work independently with passion and drive towards excellence
• Meet or exceed EXL established program productivity and quality goals
• Identify and communicate audit trends encountered during the course of daily review to manager and SME

Qualifications:

• 7+ years of experience with MS-DRG and APR-DRG auditing with expert knowledge of AHA Coding Guidelines
• Strong analytical skills, with attention to detail
• Current with industry trends specific to DRG reimbursement, provider contracts, payer policies, and audit regulations.
• One or more of the following credentials: CCS, RHIA, RHIT; preference given to those with multiple credentials
• Experience with DRG encoder tools (3M, Webstrat, Pricers)
• Prefer candidate with prior DRG retrospective overpayment identification auditing experience.

Education & Required Certification:

• Active AHIMA Registered Health Information Management Administrator with CCS
• Active AHIMA Registered Health Information Management Technician with CCS
• Active AHIMA CCS

Work Experience Requirements:

• Must have 7 years of DRG Audit experience with expert knowledge of DRG reimbursement methodologies, contract language.
• Passionate about DRG Auditing, and a desire to work in an environment that thrives on teamwork, excellence, collaboration, inclusiveness, and support.