EXL
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Healthcare Auditor III, Skilled Nursing Facility – Resource Utilization Group
Location
United States
Posted
23 hours ago
Salary
$70K - $80K / year
Bachelor Degree3 yrs expEnglish
Job Description
• Apply your expert clinical knowledge to validate the accuracy of billed charges.
• Ensure the integrity of the paid claim including coding validation, payment accuracy, contractual requirements and compliance with regulations.
• Utilize industry and EXL proprietary tools in the review process.
• Write professional communications documenting audit findings and supporting rationales.
• Identify audit trends and opportunities for improvement.
Job Requirements
- 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.
- 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.
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
- Remote work options
