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Senior Healthcare Auditor

2 months ago


West Burke, Vermont, United States EXL Full time

Company Overview:
EXL is a leading global analytics and digital solutions provider dedicated to enhancing business performance and fostering growth. Our expertise combines extensive industry knowledge with advanced data analytics, cloud technology, and artificial intelligence to deliver scalable solutions and manage complex operations for top corporations across various sectors, including insurance, healthcare, banking, and retail.

Position Overview:
We are seeking a skilled DRG Auditor III to contribute to our healthcare auditing efforts. This role offers a unique combination of remote work and travel opportunities, allowing for exploration while making a meaningful impact in the field of healthcare auditing.

Key Responsibilities:

  • Thorough Review: Execute comprehensive evaluations of medical records and coding to ensure the precision of DRG or APR DRG code assignments.
  • Onsite Audits: Conduct facility audits quarterly, both locally and out-of-state, with all travel expenses reimbursed.
  • Documentation: Prepare professional findings in accordance with EXL policies and established coding guidelines.
  • Data Management: Input all necessary DRG review data into our encoder program to secure validated DRGs.
  • Issue Identification: Recognize and assess questionable encoder outcomes with the program manager, escalating facility concerns as required.
  • Audit Tracking: Manage the status updates of audits within the audit workflow system.
  • Compliance Adherence: Follow EXL policies and HIPAA regulations while achieving set productivity and quality benchmarks.

Qualifications:

  • Education: Minimum of a High School Diploma; certifications such as CCS, CIC, or CPC with inpatient experience are preferred.
  • Experience: At least one year of inpatient hospital coding or auditing experience is required.
  • Skills: Excellent verbal and written communication abilities, willingness to travel quarterly, and capacity to work remotely.

Working Conditions:
This role involves extended periods of sitting, occasional walking, and light lifting (up to 5 pounds). Regular use of hands for keyboarding and note-taking is essential, along with the ability to read printed materials and computer screens.

Why Choose EXL?
Become part of a team that values your expertise and fosters both professional and personal growth. Enjoy the flexibility of remote work combined with exciting travel opportunities, all while playing a crucial role in ensuring accurate healthcare payments.