[Hiring] Diagnosis Related Group (DRG) / Inpatient Rehabilitation Facility (IRF) Auditor III @EXL

Role Description

EXL USA Healthcare is seeking an IRF Auditor III to join our team. This role offers a fully remote work experience with possible 10% travel per year for team meetings and limited client onsite engagements. The rest of the time, you will enjoy the flexibility of working from your home office.

Salary Range: $70,000 - $110,000 (Based on experience, skills, and qualifications)

Location: 100% Remote, U.S.-based

Travel: Up to 10% Annual Travel (Team meetings and limited client onsite engagements)

A brief coding/auditing assessment may be included as part of the interview process.

For more information on benefits and what we offer, please visit: EXL Careers and Benefits

At EXL, we believe in fostering an environment where employees can learn, grow, and succeed. We provide industry-leading training, career development opportunities, and a competitive benefits package so you can focus on delivering excellence in IRF payment integrity auditing. If you are looking for a role where your expertise can make a real impact while maintaining work-life balance, this is it!

Responsibilities

• Conduct comprehensive IRF payment integrity audits using various documentation.
• Validate IRF-PAI completion and supporting documentation based on client requirements.
• Identify documentation, coding, and reimbursement discrepancies impacting IRF payment.
• Review client payment methodology and contract requirements where applicable.
• Craft clear, concise, and well-supported audit findings.
• Collaborate with clinical SMEs, nurses, physicians, and client-facing teams.
• Manage complex and lengthy IRF records with strong attention to detail.
• Meet or exceed EXL quality and productivity standards.
• Stay current with IRF reimbursement updates and CMS guidance.
• Adhere to HIPAA, information security, and EXL policies and procedures.

Qualifications

• Minimum High School Diploma required; higher education preferred.
• CCS, CIC, CPC, RHIA, RHIT credential required; multiple credentials strongly preferred.
• Clinical licensure or rehabilitation facility experience is a plus.
• 4+ years of inpatient facility coding, auditing, payment integrity, or reimbursement review experience.
• Prior experience with IRF audits and IRF-PAI review is highly desirable.
• Strong understanding of ICD-10-CM/PCS and payer reimbursement methodologies.
• Experience reviewing lengthy medical records and tying documentation to reimbursement impact.
• Expert-level inpatient auditing mindset.
• Strong analytical, problem-solving, and critical-thinking skills.
• Self-motivated and able to work independently in a remote environment.
• Strong written and verbal communication skills.
• Proficient in Excel, Word, OneNote, and general computer literacy.
• Commitment to teamwork, collaboration, and continuous learning.

Requirements

• Inpatient Rehabilitation Facility (IRF)
• IRF-PAI
• IRF PPS / HIPPS Methodology
• ICD-10-CM/PCS
• Medical Record Review
• Payment Integrity Auditing
• Reimbursement Methodology
• Documentation Validation
• Audit Findings Writing
• Attention to Detail
• Computer Literacy
• Microsoft Office
• Internal Communications
• Interpersonal Relationship Building
• Working Under Pressure

Benefits

• A fast-paced, innovative environment with a team of industry-leading experts.
• Hands-on experience with top-tier clients in the healthcare industry.
• Mentorship and career development programs to help you grow professionally.
• A strong culture of collaboration, support, and inclusivity.
• Competitive benefits package, including healthcare, vision, dental, and 401(k) options.