APR-DRG SME (Healthcare)

EXL Health is looking for an APR-DRG Subject Matter Expert. This is 100% remote work from home opportunity!

Are you a mastery level experienced APR-DRG Auditor looking for the next step in your career path? Explore this opportunity with a new, exciting, and dynamic growth-oriented team.

In this role you will collaborate with Payment Integrity Audit program leaders, APR-DRG audit professionals and analytic team members to define new or refine existing APR-DRG audit selection criteria.

The successful candidate will be passionate, quality focused and have a background in payment integrity audits. The successful candidate shall retain a mastery level skillset in ICD 10 CM and PCS coding and extensive knowledge and expertise in the application of ICD 10 CM and PCS Guidelines for Coding & Reporting and AHA Coding Clinic. Mastery level understanding of APR-DRG reimbursement, along with staying current with regulatory changes.

Responsibilities:

• Research and analyze for new concepts and ideas from different sources to identify overpayment opportunities in APR-DRG coding.
• Create criteria document to be used by the builder to pull data and build queries.
• Screen & select claims on a monthly basis.
• Test and validate the selections output.
• Create understanding document and conduct handoff meeting with Clinical auditors on how to review and audit the new concept.
• Ensure the clinical team is calibrated with client policies and internal concepts.
• Review appeals/disputes to identify areas for improvement.
• Use Audit Outcome trend reports to monitor and fine tune existing queries.
• Collect feedback from auditors on the quality of claims and selections.

Qualifications:

• 10+ years’ experience with APR-DRGs with expert knowledge of AHA Coding Guidelines
• Experience developing audit selection criteria to identify APR-DRG coding errors and overpayments preferred
• Strong analytical skills, with attention to details
• Ability to pre-screen large data output files and provide necessary reporting
• Must stay current with industry trends specific to APR-DRG reimbursement, provider contracts, payer policies, and audit regulations
• Experience with encoder tools (TruBridge, 3M, Webstrat, Pricers)
• Excellent oral and written communication skills
• Strong skillset in Word, Excel, and PowerPoint

Education and Required Certification:

• Current AHIMA member with active RHIA, RHIT or CCS

What We Offer:

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with experienced, world class Healthcare consultants.
• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills - key aspects for personal and professional growth.
• We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors.
• Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.