In this fully remote position as a Skilled Nursing Facility auditor you will
apply your expert clinical knowledge to validate the accuracy of billed charges
to ensure the integrity of the paid claim including coding validation, payment
accuracy, contractual requirements and compliance with regulations. You will
utilize industry and EXL proprietary tools in the review process, and will write
professional communications documenting audit findings and supporting
rationales. You will also apply your extensive clinical and industry knowledge
to identify audit trends and opportunities.
Salary Range: $60,100 – $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
[https://www.exlservice.com/us-careers-and-benefits]
RESPONSIBILITIES
Conduct clinical reviews to verify the accuracy of skilled nursing facility
billing.
Apply CMS clinical guidelines and payer-provider contract terms and policies
to a variety of claim scenarios to identify overpayments for claims paid
under PDPM, RUG, and contracted per diem payment methodologies.
Apply ICD-10 coding guidelines to validate diagnoses coded on Minimum Data
Set assessment.
Document accurate audit results in a clear, concise, and effective manner
using applicable EXL tools, CMS guidelines, payer contractual terms and
policies.
Utilize proprietary workflow systems efficiently and accurately to make audit
determinations, generate audit rationales and move claims through workflow
process correctly.
Meet or exceed EXL established program productivity and quality goals.
Demonstrate knowledge of and compliance with changes and updates to clinical
guidelines, reimbursement trends, and client processes and requirements.
Comply with all EXL policies and procedures including HIPAA and other state
and federal regulations.
QUALIFICATIONS
Required:
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.
Knowledge and Skills:
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.
Works independently in a remote environment and delivers exceptional results
during EXL core business hours.
Takes ownership of problem solving.
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.