Assistant Manager - High Cost Drug (HCD) Auditor II

Job description

In this fully remote position as an HCD Auditor you will apply your expert knowledge of billing HCD claims to perform extensive audit reviews. You will utilize HCPCS codes, medical record review, industry and EXL proprietary tools in the audit process. Write professional communications documenting audit findings and supporting rationales. You will also apply your extensive industry knowledge to identify audit trends and opportunities. - Conduct HCPCS coding reviews to verify the accuracy of the coding assignment and reimbursement on high cost drug professional and outpatient facility claims. - Apply complex medical record reviews to identify discrepancies between physician orders, nursing administration logs, and final claims submissions. - Apply Medicare, Medicaid, and commercial guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications. - Document audit results in a clear, concise, and effective manner using AMA Guidelines. - Utilize proprietary workflow systems to make audit determinations, generate audit rationales, and move claims through workflow process correctly efficiently and accurately. - Acc...