Remote DRG Readmission Auditor — Expert Coding & Compliance

EXL; United States; On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Healthcare

Vision

Dental

401(k)

Job summary

EXL is seeking a Diagnosis Related Group (DRG) Readmission Auditor for a 100% remote US-based role. You will conduct MS-DRG/APR-DRG readmission reviews, apply coding guidelines, and leverage DRG encoder tools (3M, Webstrat) to identify overpayments and support audit findings.

The role requires 4+ years of MS-DRG/APR-DRG coding experience, CCS/RHIA/RHIT credentials, and the ability to work independently in a remote environment while meeting productivity standards.

Qualifications

• Minimum High School Diploma (Higher education preferred).
• CCS, RHIA, or RHIT credential (Multiple credentials preferred).
• 4+ years of MS-DRG/APR-DRG coding experience with deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies.

Responsibilities

• Conduct comprehensive MS-DRG and APR-DRG readmission 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 audit findings backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Utilize advanced DRG encoder tools 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.

Skills

Excel

Attention to detail

Analytical skills

Independent work

Education

CCS

RHIA

RHIT

Tools

3M Encoder

Webstrat

Job description

EXL is seeking a Diagnosis Related Group (DRG) Readmission Auditor for a 100% remote US-based role. You will conduct MS-DRG/APR-DRG readmission reviews, apply coding guidelines, and leverage DRG encoder tools (3M, Webstrat) to identify overpayments and support audit findings.

The role requires 4+ years of MS-DRG/APR-DRG coding experience, CCS/RHIA/RHIT credentials, and the ability to work independently in a remote environment while meeting productivity standards.