Audit Coordinator II - DME

EXL is looking for a DME Auditor. This is a remote opportunity in the US.

In this fully remote position as a DME Auditor you will apply your expert knowledge of durable medical equipment HCPCS codes and reimbursement guidelines in the auditing of professional medical records.  You will utilize industry and EXL proprietary tools in the  assignment process, and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive industry knowledge to identify audit trends and opportunities.

Responsibilities:

• Conduct HCPCS coding reviews to verify the accuracy of the coding assignment and reimbursement on durable medical equipment professional claims.
• 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 efficiently and accurately make audit determinations, generate audit rationales and move claims through workflow process correctly.
• Review provider contracts and fee schedules to determine correct payment methodology.
• Accurately reprice complex claims utilizing multiple client claims systems.
• Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
• Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, CMS, OIG and client processes and requirements.
• Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Qualifications:

• Minimum High School Diploma
• 3+ years of claims processing or DME medical billing experience with expert knowledge of Medicare and Medicaid guidelines and HCPCS codes.  
• Must have prior experience reading and interpreting contract language and fee schedules
• Prefer one or more of the following credentials: RHIA or CPC; preference given to those with multiple credentials

Knowledge & Skills:

• Expert in Medicare and Medicaid guidelines and HCPCS codes.
• Prefer experience with encoder tools and industry systems (FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, Pricers).
• Works independently in a remote environment and delivers exceptional results during EXL core business hours.
• Possesses excellent time management and work prioritization skills.
• Takes ownership of problem solving.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Intermediate skills in Word and basic computer literacy. 
• Intermediate skills in Excel include comfort working with charts, graphs and percentages.
• Basic math skills.
• Passionate about Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.

What We Offer:

At EXL Health, we provide an exciting and innovative environment where healthcare professionals come together to influence business decisions and contribute to improving the healthcare industry. Here’s what you can expect:

• Collaborative environment: Work alongside world-class healthcare consultants and be a part of a supportive team that values your input.
• Career growth: Learn new skills and gain exposure to different aspects of business operations while working in a fast-paced and engaging environment.
• Mentoring program: Receive guidance from experienced mentors who will help you develop professionally and provide career insights.
• Professional development: We encourage continuous growth and provide opportunities for you to excel within EXL Health and beyond.
• Work-life balance: Enjoy the flexibility of a remote work-from-home position, with occasional travel to expand your professional network.

At EXL Health, the sky's the limit for your professional growth. Join us and be a part of a company that values teamwork, excellence, collaboration, and support.