Skilled Nursing Facility (SNF) / Resource Utilization Group (RUG) Auditor III, Healthcare

Job description

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. A brief coding/auditing assessment may be included as part of the interview process Salary Range for this role is $70,000 - $80,000 With 10% or less travel. For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits - 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...