Skilled Nursing Facilities (SNF) Auditor III

EXL • United States,

12d • $60,100 - $98,700 • Remote

About The Position

This fully remote, U.S.-based role applies expert clinical knowledge to validate skilled nursing facility billed charges and support the integrity of paid claims. The auditor reviews coding accuracy, payment accuracy, contractual requirements, and regulatory compliance, using industry and EXL proprietary tools. The role also requires professional written communications documenting audit findings and supporting rationales, and using clinical and industry expertise to identify audit trends and opportunities.

The position may require up to 10% annual travel for team meetings and limited client onsite engagements. A brief coding or auditing assessment may be included in the interview process. The posted base salary range is $60,100–$98,700, depending on experience, skills, and qualifications. Final offers may also account for internal pay equity, work location, market conditions, and the role’s scope and responsibilities.

Requirements

• Current active RN, LPN, or LVN license.
• At least 3 years of skilled nursing experience.
• Experience or exposure to RUG and PDPM Medicare reimbursement systems and the Medicaid 48 grouper reimbursement system.
• Experience or exposure to billing HIPPS codes and days of billing for each assessment type.
• Excellent time management and work prioritization skills.
• Excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Proficiency in Excel, Word, and OneNote, with general computer literacy.
• Ability to work independently in a remote environment and deliver results during EXL core business hours.
• Problem-solving ownership.
• Interest in auditing skilled nursing claims and working in a collaborative, inclusive, team-oriented environment.

Nice To Haves

• Associate’s or bachelor’s degree for an LPN or registered nurse.
• RAC certification.
• Reimbursement experience or experience as an MDS coordinator with knowledge of PDPM/RUG.

Responsibilities

• Conduct clinical reviews to verify the accuracy of skilled nursing facility billing.
• Apply CMS clinical guidelines and payer-provider contract terms and policies to claim scenarios to identify overpayments for claims paid under PDPM, RUG, and contracted per diem payment methodologies.
• Apply ICD-10 coding guidelines to validate diagnoses coded on Minimum Data Set assessments.
• Document audit results clearly and accurately using applicable EXL tools, CMS guidelines, payer contractual terms, and policies.
• Use proprietary workflow systems to make audit determinations, generate audit rationales, and move claims through the workflow correctly.
• Meet or exceed established program productivity and quality goals.
• Stay informed about changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.
• Comply with EXL policies and procedures, including HIPAA and other state and federal regulations.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed