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About the role
Key responsibilities & impact- Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accuracy in DRG assignment and reimbursement.
- Apply expert 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.
- Adhere to HIPAA and EXL policies and procedures to ensure data security and regulatory compliance.
Requirements
What you’ll need- Minimum High School Diploma (Higher education preferred).
- CCS, RHIA, or RHIT credential (Multiple credentials preferred).
- 4+ years of MS-DRG/APR-DRG coding experience with a deep understanding of AHA Coding Guidelines and DRG reimbursement methodologies.
- Prior experience in DRG retrospective overpayment identification auditing is highly desirable.
- Strong proficiency with DRG encoder tools (3M, Webstrat).
- Expert-level inpatient coding knowledge with an in-depth understanding of ICD-10-CM/PCS coding guidelines.
- Self-motivated and able to work independently in a remote environment while maintaining high performance.
- Exceptional time management, problem-solving, and analytical skills.
- Strong written and verbal communication with attention to detail.
- Proficient in Excel, Word, and OneNote, with strong overall computer literacy.
- Passion for DRG auditing and a commitment to teamwork, collaboration, and continuous learning.
Benefits
Comp & perks- A competitive benefits package, including healthcare, vision, dental, and 401(k) options.
- Industry-leading training and career development opportunities.
- A strong culture of collaboration, support, and inclusivity.
ATS Keywords
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Hard Skills & Tools
MS-DRG codingAPR-DRG codingAHA Coding GuidelinesICD-10-CM codingICD-10-PCS codingDRG reimbursement methodologiesoverpayment identification auditingtime managementproblem-solvinganalytical skills
Soft Skills
self-motivatedindependent workattention to detailwritten communicationverbal communicationteamworkcollaborationcontinuous learning
Certifications
CCSRHIARHIT