Diagnosis-Related Group (DRG) - Auditor III, Healthcare

Are you an experienced DRG Auditor with a keen eye for detail and a passion for accuracy? Do you thrive in a challenging yet supportive environment, one where your expertise directly impacts healthcare reimbursement integrity? EXL invites you to join our dynamic team as a Diagnosis-Related Group (DRG) Auditor III, Healthcare. This is a fantastic opportunity to apply your advanced coding knowledge from anywhere in the world, as this role is fully remote. We are looking for someone ready to dive deep into complex cases, ensure precise DRG assignments, and help us maintain the highest standards of quality. If you are seeking a role where growth, learning, and a true work-life balance are not just buzzwords, but a reality, then let us connect.

Overview: Diagnosis-Related Group (DRG) Auditor III, Healthcare

EXL is actively seeking a highly skilled and dedicated Diagnosis-Related Group (DRG) Auditor III to join our expert healthcare team. This pivotal, fully remote position welcomes qualified professionals from anywhere in the world. As a DRG Auditor III, you will play a critical role in upholding the accuracy of healthcare reimbursement by conducting comprehensive reviews of complex medical records. You will leverage your extensive knowledge of coding guidelines and advanced tools to identify discrepancies, ensuring that DRG assignments are precise and compliant. At EXL, we are committed to fostering an environment where innovation thrives, and your contributions genuinely make a difference in optimizing healthcare operations.

Key Responsibilities:

Perform detailed reviews of both MS-DRG and APR-DRG coding, ensuring the utmost accuracy in DRG assignments and associated reimbursements.
Apply your expert understanding of coding guidelines, utilizing advanced, industry-leading tools to identify potential overpayments effectively.
Develop audit findings that are consistently clear, concise, and thoroughly supported by official references like AHA Coding Clinic Guidelines and current ICD-10-CM/PCS regulations.
Operate sophisticated DRG encoder tools, including platforms such as 3M and Webstrat, to enhance the efficiency and precision of all audits.
Consistently achieve or surpass EXL’s stringent quality and productivity benchmarks, notably by maintaining robust uphold rates for any appeals processes.
Remain current with the latest industry trends, coding updates, and compliance regulations, thereby sustaining your expert-level knowledge.
Ensure strict adherence to all HIPAA guidelines and EXL’s internal policies and procedures, upholding patient privacy and data security at all times.

Requirements:

Possess a relevant, active professional coding certification such as CCS, RHIA, or RHIT.
A minimum of 3-5 years of direct experience in DRG auditing within a healthcare setting.
Demonstrated expertise in MS-DRG and APR-DRG coding methodologies and official guidelines.
Proficiency with advanced DRG encoder software, including familiarity with tools like 3M or Webstrat.
Exceptional analytical skills with a meticulous attention to detail, capable of identifying subtle discrepancies in complex medical records.
Strong written and verbal communication abilities, essential for clearly articulating audit findings and engaging with various stakeholders.
A proven track record of working effectively in a remote environment, managing your workload autonomously and meeting deadlines consistently.
Commitment to continuous learning and staying current with evolving coding standards and healthcare regulations.

What You'll Gain:

An empowering work environment that actively supports your professional development and career progression.
Access to industry-leading training programs and continuous learning opportunities to sharpen your expertise.
A competitive benefits package designed to support your overall well-being and financial security.
The opportunity to make a tangible impact on healthcare reimbursement accuracy and integrity.
Enjoy genuine work-life balance in a fully remote role, allowing for flexibility and autonomy.
Join a collaborative and innovative global team where your contributions are recognized and valued.