High Cost Drug Auditor (HCD)

divh2Auditors-HCD / h2pIn this fully remote position as an HCD Auditor you will apply your expert knowledge of billing HCD claims to perform extensive audit reviews. You will utilize HCPCS codes, medical record review, industry and proprietary tools in the audit process. Write professional communications documenting audit findings and supporting rationales. You will also apply your extensive industry knowledge to identify audit trends and opportunities. / ph3Responsibilities / h3ulliConduct HCPCS coding reviews to verify the accuracy of the coding assignment and reimbursement on high cost drug professional claims. / liliApply Medicare, Medicaid and commercial guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications. / liliDocument audit results in a clear, concise, and effective manner using AMA Guidelines. / liliUtilize proprietary workflow systems to efficiently and accurately make audit determinations, generate audit rationales and move claims through workflow process correctly. / liliAccurately reprice complex claims utilizing multiple client claims systems. / liliMeet or exceed EXL established program productivity and quality goals, including uphold rate for appeals. / liliResearch prescribed drug dosage and related conditions to ensure appropriateness of medical guidelines and accuracy of reimbursement. / liliComply with all EXL policies and procedures including HIPAA and other state and federal regulations. / li / ulh3Qualifications / h3ulliExpert in HCPCS codes with advanced knowledge of medical terminology. / liliPrefer experience with encoder tools and industry systems (FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, Pricers). / liliWorks independently in a remote environment and delivers exceptional results during EXL core business hours. / liliPossesses excellent time management and work prioritization skills. / liliTakes ownership of problem solving. / liliDemonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail. / liliIntermediate skills in Word and basic computer literacy. / liliIntermediate skills in Excel including comfort working with charts, graphs and percentages. / liliBasic math skills with ability to do conversion calculations. / liliPassionate about Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support. / li / ulpEducation : / pulliMinimum High School Diploma / lili3+ years of claims processing or HCD medical billing experience with expert knowledge HCPCS codes. / liliMust have prior experience reading and interpreting contract language and fee schedules and medical record review. / liliPrefer Certified Pharmacy Technician or one or more of the following credentials : RHIA or CPC; preference given to those with multiple credentials / li / ulpSalary range $60,000.00-$90,000.00. / pp0-10% travel may be required. / ph3About Us / h3pEXL (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 worlds 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 54,000 employees spanning six continents. / ppEXL never requires or asks for fees / payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXLs Human Resources team, as well as our hiring managers. / p / div