DRG / Inpatient Auditor III

EXL•Jacksonville, FL

17h•$73,000 - $98,700•Remote

About The Position

EXL USA Healthcare is hiring a DRG / Inpatient 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 auditor reviews MS-DRG and APR-DRG coding for accurate DRG assignment and reimbursement, identifies overpayments, and prepares clear, well-supported audit findings. The role requires expert knowledge of inpatient coding guidelines, DRG reimbursement methodologies, and relevant coding tools, while meeting quality and productivity standards and protecting data in accordance with HIPAA and company policies. A brief coding or auditing assessment may be part of the interview process. The salary range is $73,000–$98,700, based on experience, skills, and qualifications, and the role is eligible for a pay-for-performance bonus. EXL offers training, career development, mentorship, and a benefits package.

Requirements

High school diploma at minimum; higher education is preferred.
One or more 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.
Self-motivation and ability to work independently in a remote environment while maintaining high performance.
Strong time management, problem-solving, and analytical skills.
Strong written and verbal communication 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.
Strong proficiency with DRG encoder tools such as 3M and Webstrat.
Higher education.
Multiple coding credentials among CCS, CIC, CPC, RHIA, and RHIT.

Responsibilities

Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accurate DRG assignment and reimbursement.
Apply coding guidelines and industry tools to maximize overpayment identifications.
Prepare clear, concise, and 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 improve audit efficiency and accuracy.
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 requirements and EXL policies and procedures to maintain data security and regulatory compliance.