Healthcare DRG Auditor III: Expert Coding & Compliance

EXL Talent Acquisition Team; United States; On-site; USD 60,000 - 90,000; Full time

Job summary

EXL is seeking a DRG auditor to conduct comprehensive MS-DRG and APR-DRG coding reviews, ensuring accuracy in DRG assignments and reimbursements.

You will apply expert coding guidelines and use tools like 3M encoder and Webstrat to identify overpayments, craft clear audit findings, and stay updated with ICD-10-CM/PCS regulations and HIPAA policies. This role emphasizes accuracy, efficiency, and regulatory compliance.

Qualifications

• Experience performing MS-DRG and APR-DRG coding reviews.
• Strong knowledge of coding guidelines and compliance requirements.
• Ability to apply HIPAA regulations in auditing processes.

Responsibilities

• Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy of DRG assignment.
• Apply expert knowledge of coding guidelines and use leading tools to maximize overpayment identifications.
• Craft clear, concise audit findings backed by guidelines and ICD-10-CM/PCS rules.
• Stay ahead of industry trends, coding updates, and regulatory changes.

Skills

MS-DRG

APR-DRG

Coding guidelines

HIPAA compliance

Tools

3M encoder

Webstrat

Job description

EXL is seeking a DRG auditor to conduct comprehensive MS-DRG and APR-DRG coding reviews, ensuring accuracy in DRG assignments and reimbursements.

You will apply expert coding guidelines and use tools like 3M encoder and Webstrat to identify overpayments, craft clear audit findings, and stay updated with ICD-10-CM/PCS regulations and HIPAA policies. This role emphasizes accuracy, efficiency, and regulatory compliance.