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

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!

💻 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:

✅ Conduct in-depth clinical reviews to verify skilled nursing facility (SNF) billing accuracy.
✅ Analyze claims paid under PDPM, RUG, and per diem payment models to identify overpayments.
✅ Apply ICD-10 coding guidelines to validate diagnoses on Minimum Data Set (MDS) assessments.
✅ Document audit findings clearly and concisely using EXL tools, CMS guidelines, and payer policies.
✅ Stay up to date on changes in clinical guidelines, reimbursement trends, and regulations.
✅ Meet or exceed productivity and quality goals in a remote, independent work environment.

What You Bring:

🔹 Required:
✔ LPN or RN (Associate’s or Bachelor’s degree preferred).
✔ 3+ years of skilled nursing experience (RAC certification, reimbursement, or MDS coordinator experience a plus!).
✔ Familiarity with PDPM, RUG, Medicaid 48 grouper reimbursement, and HIPPS codes billing.

🔹 Skills That Set You Apart:
💡 Strong analytical and problem-solving skills.
📑 Excellent written and verbal communication.
⏳ Effective time management and ability to prioritize work.
💻 Proficiency in Excel, Word, and OneNote.
🤝 A collaborative, team-oriented mindset with the ability to work independently.

Why Join EXL?

🌟 Impactful Work: Play a vital role in healthcare cost integrity and compliance.
💡 Growth & Learning: Get mentorship, hands-on experience, and career development opportunities.
🏆 Supportive Culture: We foster teamwork, inclusiveness, and professional excellence.
📈 Competitive Benefits: Healthcare, Vision, Dental, 401k, and more!

🚀 Ready to make a difference? Apply today and join EXL’s mission to drive excellence in healthcare auditing!