Diagnosis-Related Group (DRG) Auditor III
At a glance
Mid-level Audit & Controls role at Fa Ewjt Saasfaprod1. United States · full-time · $73,000–$98,700 base.
financeroles summary, based on the employer's posting.
What you'll do
- Review MS-DRG and APR-DRG coding to check whether assignments and reimbursement are accurate
- Use coding rules and DRG encoder tools to find potential overpayments and improve audit accuracy
- Write clear audit findings supported by AHA Coding Clinic guidance and ICD-10-CM/PCS regulations
- Maintain appeal uphold rates and meet quality and productivity targets
- Track coding and compliance updates, while protecting data under HIPAA and company procedures
What you bring
- At least four years of MS-DRG or APR-DRG coding work and strong knowledge of coding guidance and reimbursement methods
- A CCS, CIC, CPC, RHIA or RHIT credential
- Proficiency with DRG encoders such as 3M or Webstrat
Who this fits
This remote, U.S.-based role suits an experienced inpatient coding auditor who can work independently and communicate audit findings clearly. Travel may reach ten percent annually for team meetings and limited client-site work. A high school diploma is the minimum education requirement; further education is preferred.
From the employer
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: $73,000 – $98,700 (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 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.
Education & Credentials:
- Minimum High School Diploma (Higher education preferred).
- CCS, CIC, CPC, 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!
The posted base salary range is the hiring base salary range for this role. 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.