Diagnosis Related Group - Auditor III - Appeals

EXL was founded on the core values of innovation, collaboration, excellence, integrity, and respect. We are looking for an DRG Appeals Auditor to work 100% remotely from home!   Do you have mastery level experience as a DRG Auditor looking for the next step in your career path?  Is it time for a change?  Explore this opportunity with a new, exciting, and dynamic growth-oriented team.   In this fully remote position as a DRG Appeals Auditor you will apply your expert knowledge of DRG coding and reimbursement, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the review of provider appeal responses on EXL DRG Audits.  You will utilize industry and EXL proprietary tools in reviewing provider appeals and supporting documentation and determine if the provider appeal would revise, modify, or overturn the DRG Audit results.  You will write professional communications documenting appeal outcomes and supporting rationales. You will also apply your extensive coding and industry knowledge to identify audit trends and educational opportunities.  Mastery level understanding of MS-DRG and APR-DRG reimbursement, along with staying current with CMS changes related to IPPS is required.    Job Responsibilities: Review MS-DRG and/or APR-DRG provider appeals 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 upheld determinations. Document appeal results in a clear, concise, and effective manner citing appropriate AHA Coding Clinic Guidelines and ICD-10-CM/PCS coding rules and guidelines. Work independently with passion and drive towards excellence. Meet or exceed EXL established program productivity and quality goals. Identify and communicate appeal and audit trends encountered during the course of daily review to manager and SME. Perform MS-DRG and/or APR-DRG audits as needed.   Qualifications:   7 years of experience with MS-DRG and APR-DRG auditing with expert knowledge of AHA Coding Guidelines Strong analytical skills, with attention to detail Excellent written and verbal communication skills Current with industry trends specific to DRG reimbursement, provider contracts, payer policies, and audit regulations. One or more of the following credentials: CCS, RHIA, RHIT; preference given to those with multiple credentials Experience with DRG encoder tools (3M, Webstrat, Pricers) Prior DRG retrospective overpayment identification auditing experience   Education & Required Certification: Active AHIMA Registered Health Information Management Administrator with CCS Active AHIMA Registered Health Information Management Technician with CCS Active AHIMA CCS   Work Experience Requirements: Must have 7 years of DRG Audit experience with expert knowledge of DRG reimbursement methodologies, contract language. Prior experience managing and responding to provider DRG appeals Passionate about DRG Auditing, and a desire to work in an environment that thrives on teamwork, excellence, collaboration, inclusiveness, and support.   What We Offer:  EXL Health offers an exciting, fast paced and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants. You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors. Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond. Benefits we offer are Healthcare, Vision, Dental and 401k options.

Salary : $75,000 - $90,000