Diagnosis-Related Group (DRG) Auditor III

EXL•United States,

2d•$73,000 - $98,700•Remote

About The Position

EXL USA Healthcare is seeking a DRG Auditor III to join their team. This role offers a fully remote work experience with possible 10% travel per year. The company fosters an environment where employees can learn, grow, and succeed, providing industry-leading training, career development opportunities, and a competitive benefits package. This is a role where one can make a real impact while maintaining work-life balance.

Requirements

Minimum High School Diploma (Higher education preferred).
CCS, CIC, CPC, 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.

Nice To Haves

Higher education preferred.
Multiple credentials preferred.
Prior experience in DRG retrospective overpayment identification auditing is highly desirable.

Responsibilities

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.