Healthcare Auditor III, Skilled Nursing Facility – Resource Utilization Group

Role Overview

• 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.

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