Diagnosis Related Group (DRG) Readmission Auditor

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 readmission 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) Location: 100% Remote (U.S.-based) Up to 10% annual travel (for team meetings and limited client onsite engagements.) A brief coding/auditing assessment may be included as part of the interview process. For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits ✔ Conduct comprehensive MS-DRG and APR-DRG readmission 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. 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 readmission 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 readmission 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! 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.