Healthcare Auditor III, Skilled Nursing Facility – Resource Utilization Group
EXL
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $70,000 - $80,000 per year
About the role
- Apply your expert clinical knowledge to validate the accuracy of billed charges.
- Ensure the integrity of the paid claim including coding validation, payment accuracy, contractual requirements and compliance with regulations.
- Utilize industry and EXL proprietary tools in the review process.
- Write professional communications documenting audit findings and supporting rationales.
- Identify audit trends and opportunities for improvement.
Requirements
- RN/LPN/LVN with current active license
- LPN, Registered Nurse with Associate's or Bachelor's degree preferred
- 3+ years of skilled nursing experience with preference given to candidates with RAC certification, reimbursement or MDS coordinator with knowledge of PDPM/RUG.
- Previous experience/exposure to RUG and PDPM Medicare reimbursement systems and the Medicaid 48 grouper reimbursement system
- Previous experience/exposure to the billing of HIPPS codes and days of billing for each assessment type.
- Possesses excellent time management and work prioritization skills.
- 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 auditing skilled nursing claims with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
coding validationpayment accuracycontractual requirementscomplianceaudit trendsRAC certificationMDS coordinatorPDPMRUGHIPPS codes
Soft Skills
time managementwork prioritizationwritten communicationverbal communicationanalytical skillsattention to detailteamworkexcellencecollaborationinclusiveness
Certifications
RN licenseLPN licenseLVN license