DRG Auditor I

In this fully remote position as a new graduate, you will have the opportunity to develop your skills in auditing and compliance while working with a talented team.  The successful candidate will review outpatient medical records to ensure compliance with regulatory requirements, payer guidelines, and organizational policies. 

*Base Pay Range: $18.50 to $30.50

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

*The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. 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. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.

 Key Responsibilities:

Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
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.

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

• Required one or more of the following credentials: CCS, RHIA, RHIT, CPC 
• Associates degree or 1 year of experience 
• Knowledge of coding guidelines

Knowledge and Skills:

• Knowledge of, Official Guidelines for Coding and Reporting and Coding Clinic Guidance 
• Experience with encoder tools (3M, Webstrat, Optum Encoder).
• Works independently in a remote environment and delivers exceptional results during EXL core business hours.
• Possesses excellent time management and work prioritization skills.
• Takes ownership of problem solving.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Proficient in Excel, Word, and OneNote with general computer literacy.
• Passionate about DRG Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.

What We Offer: 

• EXL Health offers an exciting, fast paced and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.