DRG / Inpatient Auditor III

EXL•Jacksonville, FL

1d•Remote

About The Position

EXL USA Healthcare is hiring a DRG Auditor III to conduct inpatient DRG audits in a fully remote, U.S.-based role, with up to 10% annual travel for team meetings and limited client onsite engagements. The auditor reviews MS-DRG and APR-DRG coding and reimbursement, applies coding guidelines and DRG encoder tools, and prepares clear, well-supported audit findings. The role requires adherence to quality, productivity, HIPAA, and company standards, as well as staying current with coding updates and compliance regulations. A coding or auditing assessment may be included in the interview process. The posted base salary range is $73,000–$98,700, with final offers based on factors such as skills, experience, location, market conditions, and role scope.

Requirements

High school diploma or equivalent; higher education is preferred.
At least one of the following credentials: CCS, CIC, CPC, RHIA, or RHIT; multiple credentials are preferred.
At least 4 years of MS-DRG/APR-DRG coding experience.
Deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies.
Expert-level inpatient coding knowledge, including ICD-10-CM/PCS coding guidelines.
Proficiency with DRG encoder tools such as 3M and Webstrat.
Ability to work independently and stay motivated in a remote environment while maintaining high performance.
Strong time management, problem-solving, and analytical skills.
Strong written and verbal communication skills and 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.
Higher education.
Multiple coding credentials.

Responsibilities

Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accurate DRG assignment and reimbursement.
Apply coding guidelines and use industry tools to maximize overpayment identifications.
Prepare clear, concise, 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 improve audit efficiency and accuracy.
Meet or exceed quality and productivity standards, including strong uphold rates for appeals.
Stay current with industry trends, coding updates, and compliance regulations.
Follow HIPAA and EXL policies and procedures to protect data and maintain regulatory compliance.