Diagnosis-Related Group (DRG) Auditor III - Remote

EXL • Jacksonville, FL

2d • $73,000 - $98,700 • Remote

About The Position

EXL USA Healthcare is hiring a DRG Auditor III to conduct inpatient coding audits in a fully remote, U.S.-based role, with up to 10% annual travel for team meetings and limited client onsite engagements. The role focuses on reviewing MS-DRG and APR-DRG coding, identifying overpayments, and producing well-supported audit findings in accordance with coding guidelines and regulations. The auditor uses DRG encoder tools and is expected to meet EXL quality and productivity standards, including strong appeal uphold rates, while maintaining current knowledge of industry trends and compliance requirements. The position requires adherence to HIPAA and EXL policies and procedures. The posted base salary range is $73,000–$98,700, based on experience, skills, and qualifications. A coding or auditing assessment may be part of the interview process.

Requirements

• High school diploma or equivalent; higher education is preferred.
• A CCS, CIC, CPC, RHIA, or RHIT credential; multiple credentials are preferred.
• At least 4 years of MS-DRG/APR-DRG coding experience, with a deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies.
• Expert-level inpatient coding knowledge and in-depth understanding of ICD-10-CM/PCS coding guidelines.
• Proficiency with DRG encoder tools such as 3M and Webstrat.
• Ability to work independently in a remote environment while maintaining high performance.
• Strong time-management, problem-solving, analytical, written communication, and verbal communication skills, with attention to detail.
• Proficiency in Excel, Word, and OneNote, and strong overall computer literacy.
• Commitment to teamwork, collaboration, and continuous learning.

Nice To Haves

• Prior experience in DRG retrospective overpayment identification auditing is highly desirable.
• Higher education beyond a high school diploma is preferred.
• Multiple coding credentials are preferred.

Responsibilities

• Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accurate DRG assignment and reimbursement.
• Apply coding-guideline expertise and industry tools to maximize overpayment identification.
• Prepare clear, concise, and well-supported audit findings based on AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Use DRG encoder tools such as 3M and Webstrat to support efficient and accurate audits.
• Meet or exceed quality and productivity standards, including strong uphold rates for appeals.
• Keep current with industry trends, coding updates, and compliance regulations.
• Follow HIPAA and EXL policies and procedures to ensure data security and regulatory compliance.

Benefits

• Competitive benefits package, including healthcare, vision, dental, and 401(k) options.
• Industry-leading training and career development opportunities.
• Mentorship and career development programs.
• Collaborative, supportive, and inclusive culture.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED