EXL · 1 day ago

Auditor III - DRG

Syracuse-Auburn Area

Full-time

Remote

Mid Level

$75K/yr - $90K/yr

4+ years exp

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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 AHA Coding Clinic 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 coding guidelines, reimbursement trends, and client processes and requirements.

Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

CCSRHIARHITMS-DRG codingAPR-DRG codingAHA Coding GuidelinesDRG reimbursement methodologiesICD-10-CM/PCS codingDRG encoder toolsWebstratExcelWordOneNote

Required

Minimum High School Diploma

One or more of the following credentials: CCS, RHIA, RHIT; preference given to those with multiple credentials

4+ years of MS DRG/APR DRG coding experience with expert knowledge of AHA Coding Guidelines, DRG reimbursement methodologies, and familiarity with health care payer contract language.