DRG / Inpatient Auditor III

EXL•Jacksonville, FL

3d•Remote

About The Position

EXL USA Healthcare is seeking a DRG Auditor III to conduct inpatient DRG audits in a fully remote, U.S.-based role. The position may involve up to 10% annual travel for team meetings and limited client onsite engagements. The role includes reviewing MS-DRG and APR-DRG coding, identifying overpayments, and producing clear, well-supported audit findings while meeting quality and productivity standards. The salary range is $73,000–$98,700, based on experience, skills, and qualifications, with eligibility for a Pay For Performance bonus. A coding/auditing assessment may be part of the interview process. The role calls for at least four years of MS-DRG/APR-DRG coding experience and a relevant coding or health information credential. The successful candidate will work independently in a remote environment, maintain current knowledge of coding and compliance updates, and follow HIPAA and EXL policies. EXL describes its environment as fast-paced, innovative, collaborative, and supportive, with training, mentorship, and career development opportunities.

Requirements

High school diploma at minimum; 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.
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 and maintain high performance in a remote environment.
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 with DRG retrospective overpayment identification auditing.
Higher education beyond a high school diploma.
Multiple credentials among CCS, CIC, CPC, RHIA, and RHIT.

Responsibilities

Conduct comprehensive MS-DRG and APR-DRG coding reviews to verify DRG assignment and reimbursement accuracy.
Apply coding guideline expertise and industry tools to identify overpayments.
Prepare clear, concise, well-supported audit findings using 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 appeal uphold rates.
Keep current with industry trends, coding updates, and compliance regulations.
Follow HIPAA and EXL policies and procedures to protect data and maintain regulatory compliance.