Healthcare Auditor III, Skilled Nursing Facility / Resource Utilization Group
Job Description:
- 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:
- 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:
- For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
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