Diagnosis Related Group (DRG) / Inpatient Rehabilitation Facility (IRF) Auditor III

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.

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: https://www.exlservice.com/us-careers-and-benefits

Why EXL?

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

What You’ll Do:

• Conduct comprehensive IRF payment integrity audits using the IRF-PAI, UB-04/final bill, acute inpatient discharge summary, complete IRF medical record, therapy documentation, physician orders and notes, nursing notes, MAR, history and physical, pre-admission screening, individualized overall plan of care, and interdisciplinary team documentation.

• Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, date of onset, comorbid conditions, and complication/comorbidity reporting, based on client requirements and applicable CMS/IRF-PAI guidance.

• Identify documentation, coding, and reimbursement discrepancies that may impact IRF payment, including unsupported diagnoses, comorbidities not treated or not clinically supported during the IRF stay, or diagnoses carried forward from the prior acute inpatient stay without IRF-level support.

• Review client payment methodology and contract requirements where applicable, including IRF PPS/HIPPS, per diem, Medicare Advantage, Medicaid, and commercial reimbursement variations.

• Craft clear, concise, and well-supported audit findings that explain the documentation reviewed, the rationale for the finding, and the financial/reimbursement impact.

• Collaborate with clinical SMEs, nurses, physicians, analytics, and client-facing teams when audit scope includes medical necessity, contract interpretation, selection logic, or payer-specific requirements.

• Manage complex and lengthy IRF records with strong attention to detail, ensuring all relevant therapy, nursing, physician, and interdisciplinary documentation is considered before finalizing findings.

• Meet or exceed EXL quality and productivity standards while maintaining strong defensibility of audit findings and appeal outcomes.

• Stay current with IRF reimbursement updates, CMS guidance, IRF-PAI manual updates, ICD-10-CM/PCS coding updates, and payer-specific policy changes.

• Adhere to HIPAA, information security, and EXL policies and procedures to ensure data security and regulatory compliance.

Qualifications

What We’re Looking For:

Education & Credentials:

• 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 when client scope includes medical necessity review.

Experience & Expertise:

• 4+ years of inpatient facility coding, auditing, payment integrity, or reimbursement review experience.
• Prior experience with IRF audits, IRF-PAI review, IRF PPS/HIPPS methodology, rehabilitation facility documentation, or inpatient rehabilitation reimbursement is highly desirable.
• Strong understanding of ICD-10-CM/PCS, inpatient facility claim review, medical record abstraction, and payer reimbursement methodologies.
• Experience reviewing lengthy medical records and tying documentation to reimbursement impact, treatment during the IRF stay, and payer/client requirements.

Key Skills & Attributes:

• Expert-level inpatient auditing mindset with the ability to distinguish IRF-PAI documentation requirements from traditional acute-care DRG coding logic.
• Strong analytical, problem-solving, and critical-thinking skills with excellent attention to detail.
• Self-motivated and able to work independently in a remote environment while maintaining high quality and productivity.
• Strong written and verbal communication skills, including the ability to write clear audit rationale and collaborate with internal/client stakeholders.
• Proficient in Excel, Word, OneNote, and general computer literacy; experience with audit workflow tools and encoder/reference tools preferred.
• Commitment to teamwork, collaboration, continuous learning, and defensible audit outcomes.

Required Skills

What We Offer

• 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.

Ready to Take Your Career to the Next Level?

If you are looking for a rewarding and challenging opportunity where your expertise will be valued, your growth will be supported, and your contributions will make a difference, apply today and become part of the EXL team!

The posted base salary range is the hiring base salary range for this role. 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.