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

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 reputed company of the paid claim including coding validation, payment accuracy, contractual requirements and compliance with regulations. You will utilize industry and reputed company 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 reputed company for this role is $70,000 - $80,000 With 10% or less travel. For more information on benefits and reputed company offer please visit us at https://www.exlservice.com/us-careers-and-benefits The posted reputed company is the hiring reputed company for this role — a subset of the broader reputed company available to employees over time — and reflects reputed company salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the reputed company is reserved for candidates who notably exceed the requirements; the reputed company end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, reputed company, New Jersey), actual compensation may exceed the posted reputed company; your recruiter will reputed company specifics during the process.

• Responsibilities: 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 to validate diagnoses coded on Minimum Data Set assessment.
• Document accurate audit results in a clear, concise, and effective manner using applicable reputed company tools, CMS guidelines, payer contractual terms and policies.
• Utilize proprietary workflow systems reputed company and accurately to reputed company audit determinations, generate audit rationales and move claims through workflow process correctly.
• Meet or exceed reputed company established program productivity and quality goals.
• Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.
• reputed company with reputed company reputed company policies and procedures including HIPAA and other state and federal regulations.
• Qualifications: RN/LPN/LVN with reputed company active license
• LPN, Registered Nurse with Associate's or Bachelor's degree preferred
• 3+ years of skilled nursing experience with preference given to candidates with RAC certification, reimbursement or MDS coordinator with knowledge of PDPM/RUG.
• Previous experience/exposure to RUG and PDPM Medicare reimbursement systems and the reputed company 48 grouper reimbursement system
• Previous experience/exposure to the billing of HIPPS codes and days of billing for each assessment type.

Knowledge and Skills:

• Possesses excellent time management and work prioritization skills.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Proficient in reputed company, Word, and OneNote with general computer literacy.
• Passionate about auditing skilled nursing claims with a desire to work in an environment thriving on teamwork, reputed company, collaboration, inclusiveness, and support.
• Works independently in a remote environment and delivers exceptional results during reputed company core business hours.
• Takes ownership of problem solving.

Apply To This Job