Advanced Medical Auditor

2 weeks ago

Nashville, Tennessee, United States ExlService Full time

Position Title: Senior DRG Auditor

Company: EXL Health

Role Overview:
Join our team as a Senior DRG Auditor, where you will play a pivotal role in ensuring the accuracy of healthcare coding and compliance. This position combines remote work with travel opportunities, allowing you to engage with various healthcare facilities across the country.

Key Responsibilities:

  • Comprehensive Record Review: Conduct thorough evaluations of medical documentation and coding to confirm the precision of DRG or APR DRG code assignments.
  • Onsite Evaluations: Carry out facility audits on a quarterly basis, with all travel expenses reimbursed.
  • Documentation: Prepare detailed findings in accordance with company policies and established coding standards.
  • Data Management: Input all necessary DRG review data into our encoding software to ensure validated DRGs.
  • Issue Identification: Recognize and assess any discrepancies in encoder results, collaborating with management to resolve issues.
  • Audit Tracking: Maintain and update the status of audits within the audit management system.
  • Regulatory Compliance: Ensure adherence to company policies, HIPAA regulations, and meet productivity and quality benchmarks.

Qualifications:

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

Working Environment:
This role involves extended periods of sitting, occasional walking, and light lifting. Regular use of hands for typing and note-taking is required, along with the ability to read printed materials and computer screens.

Why Join EXL Health?
Become part of a team that values your expertise and fosters professional growth. Enjoy a balanced work environment that offers both remote flexibility and engaging travel experiences, all while contributing to the essential task of ensuring accurate healthcare payments.

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