Senior Diagnosis Related Group

Company Overview and Culture EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit . About EXL Health We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid. EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem. We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time. EXL was founded on the core values of innovation, collaboration, excellence, integrity, and respect. We are looking for a Sr. DRG Auditor to work 100% remotely from home. Do you have mastery level experience as a DRG Auditor looking for the next step in your career path? Is it time for a change? Explore this opportunity with a new, exciting, and dynamic growth-oriented team. In this fully remote position as a DRG Auditor you will apply your expert knowledge of DRG coding and reimbursement, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient medical records to validate or revise the provider's billed DRG code. You will utilize industry and EXL proprietary tools in the DRG assignment process and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive coding and industry knowledge to identify audit trends and identify referrals for Clinical Validation review. Mastery level understanding of MS-DRG and APR-DRG reimbursement, along with staying current with CMS changes related to IPPS. Job Responsibilities: Conduct MS-DRG and/or APR-DRG coding reviews to verify the accuracy of the DRG assignment and reimbursement. Apply coding guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications. Document audit results in a clear, concise, and effective manner using appropriate AHA Coding Clinic Guidelines and ICD-10-CM/PCS coding rules and guidelines. Work independently with passion and drive towards excellence Meet or exceed EXL established program productivity and quality goals Identify and communicate audit trends encountered during the course of daily review to manager and SME Qualifications: 7+ years of experience with MS-DRG and APR-DRG auditing with expert knowledge of AHA Coding Guidelines Strong analytical skills, with attention to detail Current with industry trends specific to DRG reimbursement, provider contracts, payer policies, and audit regulations. One or more of the following credentials: CCS, RHIA, RHIT; preference given to those with multiple credentials Experience with DRG encoder tools (3M, Webstrat, Pricers) Prefer candidate with prior DRG retrospective overpayment identification auditing experience. Education & Required Certification: Active AHIMA Registered Health Information Management Administrator with CCS Active AHIMA Registered Health Information Management Technician with CCS Active AHIMA CCS Work Experience Requirements: Must have 7 years of DRG Audit experience with expert knowledge of DRG reimbursement methodologies, contract language. Passionate about DRG Auditing, and a desire to work in an environment that thrives on teamwork, excellence, collaboration, inclusiveness, and support. EEO/Minorities/Females/Vets/Disabilities To view our total rewards offered click here -> Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits. Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy. Application & Interview Impersonation Warning - Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the "Company") for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s). EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate's full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL. Other details Pay Type Salary Min Hiring Rate $75,000.00 Max Hiring Rate $90,000.00 Telecommute % 100 Required Education Certification Apply Now Charlotte, NC, USA Chicago, IL, USA Columbus, OH, USA Dallas, TX, USA Denver, CO, USA Houston, TX, USA Jackson, MS, USA New York, NY, USA Orlando, FL, USA Virtual