What are the responsibilities and job description for the Diagnosis Related Group - Auditor III - Appeals position at EXL Services?
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 http://www.exlservice.com.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
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:
To view our total rewards offered click here — > https://www.exlservice.com/us-careers-and-benefits
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.
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 http://www.exlservice.com.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
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.
- 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
- Active AHIMA Registered Health Information Management Administrator with CCS
- Active AHIMA Registered Health Information Management Technician with CCS
- Active AHIMA CCS
- 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.
- 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.
To view our total rewards offered click here — > https://www.exlservice.com/us-careers-and-benefits
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.
