Remote DRG IRF Auditor III - Payment Integrity Expert

EXL

United States

On-site

USD 70,000 - 110,000

Full time

14 days+

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Benefits offered by this job

Healthcare

Vision

Dental

401(k)

Job summary

EXL USA Healthcare is seeking a DRG IRF Auditor III for a fully remote role with up to 10% travel for team meetings and limited client onsite engagements. The position offers a salary range of $70,000-$110,000 based on experience and qualifications, with 100% remote work based in the US.

Responsibilities include conducting IRF payment integrity audits, validating IRF-PAI, and identifying documentation and reimbursement discrepancies.

Qualifications

Minimum 4+ years in inpatient facility coding, auditing, or payment integrity.
Experience with IRF audits, IRF-PAI review, and PPS/HIPPS methodologies preferred.
Strong knowledge of ICD-10-CM/PCS and payer reimbursement.
Credentials listed are preferred; multiple credentials are a plus.

Responsibilities

Conduct IRF payment integrity audits using IRF-PAI and related documentation.
Validate IRF-PAI completion, diagnoses, onset dates, and comorbidities per CMS guidance.
Identify documentation and reimbursement discrepancies impacting IRF payments.
Review payment methodologies and contract requirements where applicable.
Craft clear audit findings with rationale and financial impact.
Collaborate with clinicians and client teams on scope and requirements.
Manage long IRF records with attention to therapy, nursing, and interdisciplinary data.
Maintain high quality and defensible audit outcomes; meet productivity standards.
Stay updated on IRF reimbursements and policy changes; ensure regulatory compliance.