Job Location : New York,NY, USA
Company Overview and Culture
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit
EXL USA Healthcare is looking for an Auditor III - DRG Coding. This position is a full-time, work from home opportunity.
In this fully remote position as a DRG Auditor you will apply your expert knowledge of DRG coding and reimbursement, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient medical records to validate or revise the provider's billed DRG code. You will utilize industry and EXL proprietary tools in the DRG assignment process, and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive coding and industry knowledge to identify audit trends and identify referrals for Clinical Validation review.
Our leadership is committed to providing employment that enables you to thrive and learn. With a competitive benefits structure and outstanding training and learning, EXL is a fantastic organization to build your career.
Responsibilities:
* Conduct MS-DRG and/or APR-DRG coding reviews to verify the accuracy of the DRG assignment and reimbursement.
* Apply coding guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications.
* Document audit results in a clear, concise, and effective manner using AHA Coding Clinic Guidelines and ICD 10 CM/PCS coding rules and guidelines.
* Utilize proprietary workflow systems and encoder tools (e.g., 3M, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
* Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
* Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements.
* Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.
Qualifications:
* Minimum High School Diploma
* One or more of the following credentials: CCS, RHIA, RHIT; preference given to those with multiple credentials
* 4+ years of MS DRG/APR DRG coding experience with expert knowledge of AHA Coding Guidelines, DRG reimbursement methodologies, and familiarity with heath care payer contract language.
* Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
Knowledge, Skills, Behaviors:
* Expert Inpatient Coding Skills. Superior knowledge of regulatory ICD-10-CM/PCS coding, Official Guidelines for Coding and Reporting and Coding Clinic Guidance coupled with MS-DRG and APR-DRG payment methodologies including Hospital Acquired Conditions (HACs), POA assignment, and Discharge Disposition codes.
* Experience with DRG encoder tools (3M, Webstrat).
* Works independently in a remote environment and delivers exceptional results during EXL core business hours.
* Possesses excellent time management and work prioritization skills.
* Takes ownership of problem solving.
* Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
* Proficient in Excel, Word, and OneNote with general computer literacy.
* Passionate about DRG Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.
EEO/Minorities/Females/Vets/Disabilities
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Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.
Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning - Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the Company ) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate's full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
Other details
* Pay Type Salary
* Min Hiring Rate $75,000.00
* Max Hiring Rate $90,000.00
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