DRG Auditor III, Healthcare

Role Overview

• Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
• Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
• Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits.
• Meet or exceed EXL’s quality and productivity standards, including strong uphold rates for appeals.
• Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge.
• Adhere to HIPAA and EXL policies and procedures to ensure data security and regulatory compliance.

Requirements

• Minimum High School Diploma (Higher education preferred).
• CCS, RHIA, or RHIT credential (Multiple credentials preferred).
• 4+ years of MS-DRG/APR-DRG coding experience with a deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies.
• Prior experience in DRG retrospective overpayment identification auditing is highly desirable.
• Strong proficiency with DRG encoder tools (3M, Webstrat).
• Expert-level inpatient coding knowledge with an in-depth understanding of ICD-10-CM/PCS coding guidelines.
• Self-motivated and able to work independently in a remote environment while maintaining high performance.
• Exceptional time management, problem-solving, and analytical skills.
• Strong written and verbal communication with attention to detail.
• Proficient in Excel, Word, and OneNote, with strong overall computer literacy.
• Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.

Benefits

• Health insurance
• Vision insurance
• Dental insurance
• 401(k) options
• Professional development opportunities
• Flexible work arrangements