DRG Auditor III

EXL; United States; On-site; USD 73,000 - 99,000; Full time

Benefits offered by this job

Healthcare benefits

Vision and dental

401(k) plan

Mentorship program

Job summary

EXL USA Healthcare is seeking a DRG Auditor III for a fully remote role with up to 10% travel. You will conduct comprehensive MS-DRG and APR-DRG coding reviews, apply coding guidelines, and use DRG encoder tools to drive accuracy.

Ideal candidates have 4+ years of MS-DRG/APR-DRG experience, certifications like CCS/CIC/CPC/RHIA/RHIT, and strong analytical and communication skills. This position offers competitive benefits and opportunities to grow within a dynamic team.

Qualifications

• 4+ years MS-DRG/APR-DRG coding experience with knowledge of AHA Guidelines and DRG reimbursement
• Experience in DRG retrospective overpayment auditing is desirable
• Proficient with DRG encoder tools (3M, Webstrat)

Responsibilities

• Conduct comprehensive MS-DRG and APR-DRG coding reviews for accurate reimbursement.
• Apply coding guidelines and utilize tools to maximize overpayment identifications.
• Draft clear audit findings per ICD-10-CM/PCS regulations and AHA guidelines.
• Utilize DRG encoder tools to improve audit efficiency and accuracy.
• Meet EXL quality and productivity standards, including high appeal uphold rates.
• Stay updated on coding updates and regulatory changes.
• Adhere to HIPAA and EXL policies for data security and compliance.

Skills

Inpatient coding

ICD-10-CM/PCS

Remote work

Time management

Analytical skills

Communication

Education

High School Diploma

CCS, CIC, CPC, RHIA, or RHIT credentials

Tools

3M Encoder

Webstrat

Job description

Are you a passionate and experienced DRG Auditor looking for an opportunity to thrive in a dynamic, innovative environment? EXL USA Healthcare is seeking a DRG Auditor III to join our team! This role offers a fully remote work experience with possible 10% travel per year. The rest of the time, you'll enjoy the flexibility of working from your home office.

Why EXL?

At EXL, we believe in fostering an environment where our employees can learn, grow, and succeed. We provide industry-leading training, career development opportunities, and a competitive benefits package to ensure you can focus on what you do best—delivering excellence in DRG auditing. If you're looking for a role where you can make a real impact while maintaining work-life balance, this is it!

Salary Range: $73,000 – $98,700

Location: 100% Remote (U.S.-based)

Up to 10% annual travel (for team meetings and limited client onsite engagements.)

A brief coding/auditing assessment may be included as part of the interview process.

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

Responsibilities

• Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
• Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
• Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits.
• Meet or exceed EXL’s quality and productivity standards, including strong uphold rates for appeals.
• Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge.
• Adhere to HIPAA and EXL policies and procedures to ensure data security and regulatory compliance.

Qualifications

Education & Credentials:

• Minimum High School Diploma (Higher education preferred).
• CCS, CIC, CPC, RHIA, or RHIT credential (Multiple credentials preferred).

Experience & Expertise:

• 4+ years of MS-DRG/APR-DRG coding experience with a deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies.
• Prior experience in DRG retrospective overpayment identification auditing is highly desirable.
• Strong proficiency with DRG encoder tools (3M, Webstrat).

Key Skills & Attributes:

• Expert-level inpatient coding knowledge with an in-depth understanding of ICD-10-CM/PCS coding guidelines.
• Self-motivated and able to work independently in a remote environment while maintaining high performance.
• Exceptional time management, problem-solving, and analytical skills.
• Strong written and verbal communication with attention to detail.
• Proficient in Excel, Word, and OneNote, with strong overall computer literacy.
• Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.

What We Offer:

• A fast-paced, innovative environment with a team of industry-leading experts.
• Hands-on experience with top-tier clients in the healthcare industry.
• Mentorship and career development programs to help you grow professionally.
• A strong culture of collaboration, support, and inclusivity.
• Competitive benefits package, including healthcare, vision, dental, and 401(k) options.

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.