DRG Auditor III - Travel Required 6 Weeks Per Quarter

EXL Health is hiring a DRG Auditor III. This Hybrid role requires auditing in specific provider location in San Antonio, TX and Nashville, TN. To be onsite at the provider location will require some travel each quarter. The amount of travel outside the metropolitan area will vary based on your location / proximity to client facilities and Client need:  

• Approximately 6 weeks of travel needed per quarter to client sites in San Antonio, TX and Nashville, TN.
• Future travel locations may include Tampa, FL and Richmond, VA.
• Hybrid: Remote auditing when not onsite auditing.

Note that travel expenses will be reimbursed.

The responsibilities of the DRG Coding Auditor is to perform DRG reviews by validating accuracy of the DRG or APR DRG code assignment completeness, POA, discharge status, etc to ensure accurate payment by our clients. The coding auditor determines if a discrepancy exists in the coding and documents the findings using standard documentation guidelines applicable to the program. The audits can be done as desk or as onsite in which case the coding auditor might have to travel to the providers location on an agreed upon schedule and perform the audit review. 

Essential Duties and Responsibilities

• Reviews medical records and coding to validate clinical coding
• Facility onsite auditing once per quarter at local area and/or out of state facility. Expenses paid.
• Ability to write professional finding notes based on EXL policies using official coding guidelines, ICD-10 coding handbook, coding clinic or other recognized sources
• Enters all required DRG review information into encoder program to obtain validated DRG
• Identifies questionable encoder results and reviews with program manager
• Takes responsibility for updating status of audit in the audit workflow system
• Schedules and performs onsite audits in accordance with the program policies and procedures
• Works independently-
• Needs to meet established program productivity and quality goals
• Escalates facility issues to manager for resolution
• Review appeal information and render coding decision to either uphold or overturn original finding
• Participate in Inter Rater Reliability quality reviews
• Comply with all EXL Employee Handbook policies and procedures
• Comply with HIPAA and other regulations regarding confidentiality of information
• Adhere to established EXL Policies and Procedures
• Perform other duties as assigned.

Education Requirements

• Minimum High School Diploma · CCS, CIC, CPC with Inpatient Experience

Work Experience Requirements

• Required: 1 year inpatient hospital coding or auditing experience

Skills and Behavior Requirements

• Good verbal and written communication skills
• Hybrid: Must be able to travel quarterly to onsite facility locally and/or out of state, as well as work remotely.

Working Conditions, Physical and Mental Demands

• Sitting for extended periods of time;
• Walking or transferring through the required office workspaces, as necessary to perform expected responsibilities and duties;
• Lifting up to 5 pounds;
• Ability to commute to and from work at each appointed work time;
• Mobility Requirements include regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies.

• ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less;
• Dexterity Requirements include regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment;
• Hearing/Talking Requirements include the ability to hear normal speech, hear and talk to exchange information in person and on telephone.

• Flexibility to work varied shifts and hours to meet business needs;
• Communicating verbally and in written English language to meet business needs;
• Handling difficult conversations with determinations of requests and notifications to providers and members.

Contents of the job description is not restricted from change. Management retains the right to assign, reassign duties and responsibilities at any time to meet the business obligations and expectations.