Skilled Nursing Facility (SNF) Auditor III

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.

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.

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.