EXL USA Healthcare is seeking an IRF Auditor III to join our team. This role
offers a fully remote work experience with possible 10% travel per year for team
meetings and limited client onsite engagements. The rest of the time, you will
enjoy the flexibility of working from your home office.
Salary Range
$70,000 - $110,000
Based on experience, skills, and qualifications
Location
100% Remote
U.S.-based
Travel
Up to 10% Annual Travel
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:
https://www.exlservice.com/us-careers-and-benefits
Why EXL?
At EXL, we believe in fostering an environment where employees can learn, grow,
and succeed. We provide industry-leading training, career development
opportunities, and a competitive benefits package so you can focus on delivering
excellence in IRF payment integrity auditing. If you are looking for a role
where your expertise can make a real impact while maintaining work-life balance,
this is it!
RESPONSIBILITIES
What You’ll Do:
Conduct comprehensive IRF payment integrity audits using the IRF-PAI,
UB-04/final bill, acute inpatient discharge summary, complete IRF medical
record, therapy documentation, physician orders and notes, nursing notes,
MAR, history and physical, pre-admission screening, individualized overall
plan of care, and interdisciplinary team documentation.
Validate IRF-PAI completion and supporting documentation, including
impairment group, etiologic diagnosis, date of onset, comorbid conditions,
and complication/comorbidity reporting, based on client requirements and
applicable CMS/IRF-PAI guidance.
Identify documentation, coding, and reimbursement discrepancies that may
impact IRF payment, including unsupported diagnoses, comorbidities not
treated or not clinically supported during the IRF stay, or diagnoses carried
forward from the prior acute inpatient stay without IRF-level support.
Review client payment methodology and contract requirements where applicable,
including IRF PPS/HIPPS, per diem, Medicare Advantage, Medicaid, and
commercial reimbursement variations.
Craft clear, concise, and well-supported audit findings that explain the
documentation reviewed, the rationale for the finding, and the
financial/reimbursement impact.
Collaborate with clinical SMEs, nurses, physicians, analytics, and
client-facing teams when audit scope includes medical necessity, contract
interpretation, selection logic, or payer-specific requirements.
Manage complex and lengthy IRF records with strong attention to detail,
ensuring all relevant therapy, nursing, physician, and interdisciplinary
documentation is considered before finalizing findings.
Meet or exceed EXL quality and productivity standards while maintaining
strong defensibility of audit findings and appeal outcomes.
Stay current with IRF reimbursement updates, CMS guidance, IRF-PAI manual
updates, ICD-10-CM/PCS coding updates, and payer-specific policy changes.
Adhere to HIPAA, information security, and EXL policies and procedures to
ensure data security and regulatory compliance.
QUALIFICATIONS
What We’re Looking For:
Education & Credentials:
Minimum High School Diploma required; higher education preferred.
CCS, CIC, CPC, RHIA, RHIT credential required; multiple credentials strongly
preferred.
Clinical licensure or rehabilitation facility experience is a plus when
client scope includes medical necessity review.
Experience & Expertise:
4+ years of inpatient facility coding, auditing, payment integrity, or
reimbursement review experience.
Prior experience with IRF audits, IRF-PAI review, IRF PPS/HIPPS methodology,
rehabilitation facility documentation, or inpatient rehabilitation
reimbursement is highly desirable.
Strong understanding of ICD-10-CM/PCS, inpatient facility claim review,
medical record abstraction, and payer reimbursement methodologies.
Experience reviewing lengthy medical records and tying documentation to
reimbursement impact, treatment during the IRF stay, and payer/client
requirements.
Key Skills & Attributes:
Expert-level inpatient auditing mindset with the ability to distinguish
IRF-PAI documentation requirements from traditional acute-care DRG coding
logic.
Strong analytical, problem-solving, and critical-thinking skills with
excellent attention to detail.
Self-motivated and able to work independently in a remote environment while
maintaining high quality and productivity.
Strong written and verbal communication skills, including the ability to
write clear audit rationale and collaborate with internal/client
stakeholders.
Proficient in Excel, Word, OneNote, and general computer literacy; experience
with audit workflow tools and encoder/reference tools preferred.
Commitment to teamwork, collaboration, continuous learning, and defensible
audit outcomes.
Required Skills
Inpatient Rehabilitation Facility (IRF)
IRF-PAI
IRF PPS / HIPPS Methodology
ICD-10-CM/PCS
Medical Record Review
Payment Integrity Auditing
Reimbursement Methodology
Documentation Validation
Audit Findings Writing
Attention to Detail
Computer Literacy
Microsoft Office
Internal Communications
Interpersonal Relationship Building
Working Under Pressure
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 are 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.
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and
solutions company. We partner with clients using a data and AI-led approach to
reinvent business models, drive better business outcomes and unlock growth with
speed. EXL harnesses the power of data, analytics, AI, and deep industry
knowledge to transform operations for the world’s leading corporations in
industries including insurance, healthcare, banking and financial services,
media and retail, among others. EXL was founded in 1999 with the core values of
innovation, collaboration, excellence, integrity and respect. We are
headquartered in New York and have more than 54,000 employees spanning six
continents. For more information, visit www.exlservice.com
[http://www.exlservice.com/].
EXL never requires or asks for fees/payments or credit card or bank details
during any phase of the recruitment or hiring process and has not authorized any
agencies or partners to collect any fee or payment from prospective candidates.
EXL will only extend a job offer after a candidate has gone through a formal
interview process with members of EXL’s Human Resources team, as well as our
hiring managers.
EXL is the indispensable partner for leading businesses in data-led industries
such as insurance, banking and financial services, healthcare, retail and
logistics. We bring a unique combination of data, advanced analytics, digital
technology and industry expertise to help our clients turn data into insights,
streamline operations, improve customer experience, and transform their
business. Our partnerships with clients are built on a foundation of
collaboration – and we’ve been chosen as a partner by nine of the top ten
leading US insurance companies, nine of the top 20 global banks, and six of the
top ten US health care payers. We function as one team to make your goals our
goals, whether that’s unlocking the value of generative AI or embedding
analytics into workflows that reduce risk or power your growth. Clients choose
EXL as their transformation partner for many reasons. Our geographic diversity
make talent all over the world instantly accessible. Digital accelerators enable
unmatched speed-to-value, letting you realize results fast. It’s our people that
truly set us apart, though, including the 1,500 data scientists we have
dedicated to our generative AI practice. And our more than twenty years of
experience in delivering business services, garnering stellar client references,
and maintaining a solid balance sheet are reassuring to our C-suite clients.
Find out for yourself why clients, employees, and analysts think we’re some of
the best in the business. Contact us to see how we can help you achieve your
goals.