EXL is a global company providing business process solutions engineered to help companies streamline operations, simplify compliance, prepare for change, and cr
Diagnosis Related Group Auditor III, Healthcare
Location
United States
Posted
1 day ago
Salary
$70K - $105K / year
Seniority
Senior
No structured requirement data.
Job Description
Diagnosis Related Group Auditor III, Healthcare
EXL
Title: Diagnosis-Related Group (DRG) Auditor III, Healthcare -Remote US Job Description: Job Identification; 14770 Job Role; Auditor-DRG Experience (In Years); 3-6 Job Location; Remote US Job Description Are you a passionate and experienced DRG Auditor looking for an opportunity to thrive in a dynamic, innovative environment? EXL USA Healthcare is seeking a DRG Auditor III to join our team! This role offers a fully remote work experience with possible 10% travel per year. The rest of the time, you'll enjoy the flexibility of working from your home office. Why EXL? At EXL, we believe in fostering an environment where our employees can learn, grow, and succeed. We provide industry-leading training, career development opportunities, and a competitive benefits package to ensure you can focus on what you do best—delivering excellence in DRG auditing. If you're looking for a role where you can make a real impact while maintaining work-life balance, this is it! Salary Range: $70,000 – $110,000 (based on experience, skills, and qualifications) Up to 10% annual travel (for team meetings and limited client onsite engagements.) The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process. Responsibilities What You’ll Do: 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. Qualifications What We’re Looking For: Education & Credentials: - Minimum High School Diploma (Higher education preferred). - CCS, RHIA, or RHIT credential (Multiple credentials preferred). Experience & Expertise: - 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). Key Skills & Attributes: 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. What We Offer: A fast-paced, innovative environment with a team of industry-leading experts. Hands-on experience with top-tier clients in the healthcare industry. Mentorship and career development programs to help you grow professionally. A strong culture of collaboration, support, and inclusivity. Competitive benefits package, including healthcare, vision, dental, and 401(k) options. Ready to Take Your Career to the Next Level? If you're looking for a rewarding and challenging opportunity where your expertise will be valued, your growth will be supported, and your contributions will make a difference—apply today and become part of the EXL team! Required Skills - APR-DRG - Attention To Consistency - Computer Literacy - Diagnosis-Related Group (DRG) - Internal Communications - Interpersonal Relationship Building - Leadership Capabilities - MS-DRG - Microsoft Office - Working under Pressure About Us EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com. EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.
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And we provide nursing education administrators and faculty with best-in-class support and expertise from some of the sharpest minds in nursing education. We aid nurse educators in understanding students' comprehension based on nearly two decades of data — including more than 12 million proctored assessments — that detail student learning and performance. The result is customers who are confident in their program offerings and positioned for healthy outcomes. WHAT YOU'LL DO As a Nurse Educator in Consulting Services, you’ll be part of an enthusiastic team dedicated to enhancing professional development and curriculum accreditation for nursing educators and administrators. You’ll focus on developing and implementation of program management solutions including curriculum accreditation, systematic evaluation plans, clinical site management, and program evaluation to improve client success. 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Internal Audit Analyst (Mid-level) – Regulatory and Operations Focus
ASAASSimplificamos o recebimento de cobranças para pessoa física, MEIs e grandes empresas.
• Execute internal audits focused on operational, regulatory and technology processes (including US GAAP and SOX requirements), under the coordination of area management; • Participate in audit planning and perform audit tests, ensuring compliance with Brazilian and international standards; • Prepare workpapers and audit reports with clarity and technical quality, supporting the translation of findings and recommendations to the business areas; • Assess the design and operating effectiveness of internal controls, with a focus on risk mitigation, compliance and integrity of information for Brazilian and foreign regulators; • Monitor the implementation of action plans resulting from audit findings, performing continuous follow-up; • Support initiatives to adapt the control and governance environment to capital markets requirements and IPO readiness; • Participate in meetings with audited areas, propose improvements and contribute to a culture of compliance and operational excellence; • Collaborate on digital transformation projects and initiatives within the audit function.
Role Description As a Quality Auditor, you are responsible for all contact center quality assurance, associated with inbound/outbound calls, for all agents in Patient Access Management. You will score multiple calls on quality and audit all agents in Access Management. You will report findings to leadership for training, feedback and resolutions on performance. The position requires the ability to maintain friendly and appropriate communication in any situation. Knowledge and understanding of ATI standard operating procedures, multiple software programs/platforms and workflows per team are required. You are focused on delivering and contributing to the exceptional customer experience promise every day. The Quality Auditor must be motivated, professional, and energetic and be ready to work in a fast-paced, ever-changing environment. You must maintain a positive attitude, be a team player, and adhere to the ATI Physical Therapy core values and culture. You will need to provide exemplary customer service to both internal and external customers and meet and maintain monthly productivity standards of quality and quantity. This is a remote position for United States based employees. Work schedule Monday to Friday between the hours 7:00am and 7:00pm Central time. Responsibilities - Auditing interactions both inbound and outbound. - Analyzing agent behaviors and problem-solving skills. - Communicate findings to leadership at an agreed upon cadence. - Identify opportunities to improve the workflow through Quality Data. - Provide positive coaching upholding the highest level of customer service. Qualifications - High School Diploma, GED Requirements - 1-2 Year Call Center Experience - 1 Year Healthcare - Preferred: 4 years Call Center Experience - Preferred: 4 years Healthcare - Knowledge of EMR/Patient Intake Process - Quality Management Platforms - Sufficient Knowledge in Microsoft Office - Knowledge of Workforce Management Platforms Benefits - Salary Range: $20.00-$24.00 Company Description Virtual Employee: Yes
Role Description As the Lead Quality Auditor, you play a pivotal role in elevating the quality of contact center patient-support interactions, supporting the QA Manager in driving analytics, process improvement, and program governance. In addition to performing call evaluations, you will lead critical functions across the QA team, own key reporting and trend analysis, and serve as the liaison between QA, Operations, and Training. The Lead Quality Auditor will ensure consistency in scoring, amplify insights from data, and act as the manager’s right hand to drive continuous improvement in access management performance. This is a remote position for United States based employees. Work schedule hours Monday to Friday between the hours of 7:00am and 7:00pm Central time. Responsibilities - Act as a subject-matter-expert for QA methodology: refine and maintain the evaluation of scorecards/forms, ensure they reflect business objectives, regulatory/compliance requirements, and patient support requirements. - Support training and coaching of QA auditors: onboarding new auditors, training on scoring, ensuring auditing best practices, peer reviews of auditor work. - Monitor and report on QA team productivity (e.g., number of calls scored, timeliness of reports, auditor calibration percentages). Generate and distribute regular, actionable QA reports (weekly, monthly, quarterly) that include trends, root-cause analysis, score distributions, agent team performance, and improvement opportunities. - Support ongoing improvement efforts of the Access Management Contact Center: Participate in projects, update processes, and ensure new initiatives are implemented in the QA framework. Adhere to and promote compliance with all relevant regulatory, compliance and service standards (especially as it relates to patient support and healthcare environment). - Lead calibration sessions across the QA auditor team and with supervisors to ensure consistent scoring standards and reliability of data. Partner with Supervisors/Operations to communicate quality feedback, participate in huddles or team meetings as needed, and help align agent coaching initiatives with QA findings. - Serve as a catalyst for complex QA issues (e.g., inconsistent scoring, unusual calls, process breakdowns) and support manager with resolution. - Perform monitoring and scoring of customer support calls per defined schedule (in addition to audits) to maintain firsthand contact with agent interactions (as needed). 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Salary Range $21.78-$26.23 per hour


