DRG / Inpatient Auditor III

About the role

EXL USA Healthcare is seeking a DRG Auditor III for a fully remote, U.S.-based position, with possible up to 10% travel per year for team meetings and limited client site visits. The role involves reviewing hospital inpatient coding and identifying overpayments. The salary range is $73,000 - $98,700 depending on experience, skills and qualifications.

Key responsibilities

• Conduct comprehensive MS-DRG and APR-DRG coding reviews to ensure accurate DRG assignment and reimbursement.
• Use coding guidelines and industry tools to identify overpayments.
• Write clear, well-supported audit findings based on AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
• Use advanced DRG encoder tools such as 3M and Webstrat.
• Meet or exceed quality and productivity standards, including strong appeal-uphold rates.
• Stay current on coding updates and compliance regulations, and follow HIPAA and company policies.

Required profile

• Minimum high school diploma; higher education preferred.
• CCS, CIC, CPC, RHIA or RHIT credential (multiple preferred).
• 4+ years of MS-DRG/APR-DRG coding experience and understanding of AHA Coding Guidelines and DRG reimbursement.
• Prior experience in retrospective overpayment auditing is highly desirable.
• Able to work independently in a remote setting with strong time management, problem-solving and communication skills.

Required skills

• Expert inpatient coding knowledge and ICD-10-CM/PCS.
• Strong proficiency with DRG encoder tools (3M, Webstrat).
• Proficiency in Excel, Word and OneNote.

What we offer

• Training, mentorship and career development programs.
• Competitive benefits including healthcare, vision, dental and 401(k) options.
• A fast-paced, collaborative environment with hands-on work with top healthcare clients.