EXL Service Philippines, Inc. ยท 3 days ago
Auditor III - CVA
Jacksonville, TX
Full-time
Remote
Mid, Senior Level
5+ years exp
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Responsibilities
Conduct MS-DRG and/or APR-DRG clinical reviews to verify the accuracy of the DRG assignment and reimbursement.
Apply clinical 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 clinical guidelines and ICD 10 CM/PCS coding rules and guidelines.
Utilize proprietary workflow systems and encoder tools (e.g., 3M, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.
Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.
Qualification
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Required
Registered Nurse, Associate's or Bachelor's degree
5+ years of acute care nursing experience
Extensive knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments
Experience with DRG encoder tools (3M, Webstrat)
Works independently in a remote environment and delivers exceptional results during EXL core business hours
Possesses excellent time management and work prioritization skills
Takes ownership of problem solving
Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail
Proficient in Excel, Word, and OneNote with general computer literacy
Passionate about DRG Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support
Preferred
Prior clinical or coding validation audit experience
Prior DRG retrospective overpayment identification auditing experience
CCS, RHIA, or RHIT coding credentials
Benefits
Paid Time Off policy
Bonuses
Region specific benefits
Company
EXL Service Philippines, Inc.
EXL Service is an American multinational professional services company mainly involved in the operations management and analytics.
10001+ employees
Funding
Current Stage
Late StageCompany data provided by crunchbase
