Skilled Nursing Facility (SNF) / Resource Utilization Group (RUG) - Auditor III, Healthcare
Company Overview and Culture
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 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
Skilled Nursing Facility (SNF) / Resource Utilization Group (RUG) - Auditor III, Healthcare (Remote) – Join Our EXL Team!
Are you passionate about healthcare auditing? Do you have a keen eye for detail and a deep understanding of Skilled Nursing Facility (SNF) billing and reimbursement? If so, EXL wants you on our team as an Auditor III – SNF/RUG!
π» Remote Opportunity – Work from Home!
At EXL, we bring together sharp, innovative professionals eager to make an impact in healthcare. In this role, you'll apply your clinical expertise to review claims, validate charges, and ensure compliance—all while working in a dynamic, collaborative environment.
What You’ll Do:
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Conduct in-depth clinical reviews to verify skilled nursing facility (SNF) billing accuracy.
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Analyze claims paid under PDPM, RUG, and per diem payment models to identify overpayments.
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Apply ICD-10 coding guidelines to validate diagnoses on Minimum Data Set (MDS) assessments.
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Document audit findings clearly and concisely using EXL tools, CMS guidelines, and payer policies.
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Stay up to date on changes in clinical guidelines, reimbursement trends, and regulations.
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Meet or exceed productivity and quality goals in a remote, independent work environment.
What You Bring:
πΉ Required:
β LPN or RN (Associate’s or Bachelor’s degree preferred).
β 3+ years of skilled nursing experience (RAC certification, reimbursement, or MDS coordinator experience a plus!).
β Familiarity with PDPM, RUG, Medicaid 48 grouper reimbursement, and HIPPS codes billing.
πΉ Skills That Set You Apart:
π‘ Strong analytical and problem-solving skills.
π Excellent written and verbal communication.
β³ Effective time management and ability to prioritize work.
π» Proficiency in Excel, Word, and OneNote.
π€ A collaborative, team-oriented mindset with the ability to work independently.
Why Join EXL?
π Impactful Work: Play a vital role in healthcare cost integrity and compliance.
π‘ Growth & Learning: Get mentorship, hands-on experience, and career development opportunities.
π Supportive Culture: We foster teamwork, inclusiveness, and professional excellence.
π Competitive Benefits: Healthcare, Vision, Dental, 401k, and more!
π Ready to make a difference? Apply today and join EXL’s mission to drive excellence in healthcare auditing!
To view our total rewards offered click here —> https://www.exlservice.com/us-careers-and-benefits
Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.
Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
Other details
- Pay Type Salary
- Employment Indicator Regular
- Min Hiring Rate $70,000.00
- Max Hiring Rate $80,000.00
- Travel Required No
- Telecommute % 100
- Required Education Associate Degree
- United States
- Virtual