Diagnosis-Related Group (DRG) Auditor III
About the Role
Join Our Team as a DRG Auditor III – Make an Impact in Healthcare!
Full Job Posting
Qualifications
- Education & Credentials:
- Minimum High School Diploma (Higher education preferred).
- CCS, CIC, CPC, RHIA, or RHIT credential (Multiple credentials preferred).
- Experience & Expertise:
- 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).
- Key Skills & Attributes:
- 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.
What We Offer:
- A fast-paced, innovative environment with a team of industry-leading experts.
- Hands-on experience with top-tier clients in the healthcare industry.
- Mentorship and career development programs to help you grow professionally.
- A strong culture of collaboration, support, and inclusivity.
- Competitive benefits package, including healthcare, vision, dental, and 401(k) options.
- Ready to Take Your Career to the Next Level?
- If you're looking for a rewarding and challenging opportunity where your expertise will be valued, your growth will be supported, and your contributions will make a difference—apply today and become part of the EXL team!
- The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.
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.
Preferred Qualifications
- Minimum High School Diploma (Higher education preferred).
- CCS, CIC, CPC, RHIA, or RHIT credential (Multiple credentials preferred).
About EXL
EXL is a global data and AI company that provides analytics, digital operations, and industry-specific services to enterprises in insurance, healthcare, banking, retail, media, and energy.
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