Resource Utilization Group Auditor III – Skilled Nursing Facility, SNF
EXL
Job Level
Mid-LevelSenior
About the role
- Audit Home Health medical records to validate or revise billed services based on CMS guidelines
- Apply clinical judgment and coding expertise to identify overpayments and ensure proper reimbursement
- Document audit findings using OASIS, ICD-10 CM, and CMS Home Health guidelines
- Utilize tools like Decision Health, Webstrat, and proprietary EXL platforms to complete audits
- Identify audit trends and recommend improvements benefiting providers and patients
- Stay current on clinical and reimbursement guidelines and meet productivity and quality benchmarks
Requirements
- LPN or Registered Nurse (Associate’s or Bachelor’s degree preferred)
- 3+ years of acute care nursing experience
- Prior experience in Home Health auditing (essential)
- Strong consideration for candidates holding OASIS or Coding certifications
- Deep knowledge of PDGM and PPS payment methodologies
- Proficiency in auditing and coding tools (Decision Health, ICD-10, Webstrat)
- Strong command of Microsoft Office (Excel, Word, OneNote)
- Exceptional time management, attention to detail, and independent work ethic
- Clear and confident communicator – both in writing and verbally
- Passion for improving healthcare through teamwork, collaboration, and continuous learning
