Healthcare Auditor III, Skilled Nursing Facility / Resource Utilization Group

EXL

Remote Skilled Nursing Facility auditor role at EXL validating billing accuracy and compliance with regulations. Utilizing clinical knowledge to identify trends and opportunities in auditing.

Posted 6/5/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $70,000 - $80,000 per yearWebsite

About the role

Key responsibilities & impact

In this fully remote position as a Skilled Nursing Facility auditor you will apply your expert clinical knowledge to validate the accuracy of billed charges to ensure the integrity of the paid claim including coding validation, payment accuracy, contractual requirements and compliance with regulations.
You will utilize industry and EXL proprietary tools in the review process, and will write professional communications documenting audit findings and supporting rationales.
You will also apply your extensive clinical and industry knowledge to identify audit trends and opportunities.

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.
**Knowledge and Skills:**
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.
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

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Hard Skills & Tools

coding validationpayment accuracycontractual requirementscomplianceRAC certificationMDS coordinatorPDPMRUGHIPPS codesbilling

Soft Skills

time managementwork prioritizationwritten communicationverbal communicationanalytical skillsattention to detailteamworkcollaborationinclusivenessproblem solving

Certifications

RN licenseLPN licenseLVN license