Skilled Nursing Facility / Resource Utilization Group Auditor III, Healthcare

EXL

Auditing skilled nursing facility claims ensuring accuracy of billing in a fully remote role. Requires strong clinical knowledge and experience with Medicare reimbursement systems.

Posted 4/17/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $80,000 per yearWebsite

About the role

Key responsibilities & impact

Apply your expert clinical knowledge to validate the accuracy of billed charges to ensure the integrity of the paid claim.
Conduct clinical reviews to verify the accuracy of skilled nursing facility billing.
Apply CMS clinical guidelines and payer-provider contract terms and policies to a variety of claim scenarios to identify overpayments for claims paid under PDPM, RUG, and contracted per diem payment methodologies.
Apply ICD-10 coding guidelines to validate diagnoses coded on Minimum Data Set assessment.
Document accurate audit results in a clear, concise, and effective manner using applicable EXL tools, CMS guidelines, payer contractual terms and policies.
Utilize proprietary workflow systems efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
Meet or exceed EXL established program productivity and quality goals.
Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.
Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Requirements

What you’ll need

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.
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.
Works independently in a remote environment and delivers exceptional results during EXL core business hours.
Takes ownership of problem solving.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

ICD-10 codingclinical reviewsbilling accuracyaudit documentationRUGPDPMHIPPS codingMDS assessmentreimbursement systemsclinical guidelines

Soft Skills

time managementwork prioritizationwritten communicationverbal communicationanalytical skillsattention to detailproblem solvingteamworkcollaborationindependence

Certifications

RN licenseLPN licenseLVN licenseRAC certification