About this role
As a DME Auditor, you’ll use your deep understanding of Durable Medical Equipment (DME), Medicare, Medicaid, and commercial reimbursement rules to review professional claims and ensure proper coding and payment. You’ll analyze claims, document your findings clearly, and help our clients recover overpayments—all while making a direct impact on healthcare efficiency.
- Review medical records to verify services were provided as billed for Hospital Bill Audit reviews.
- Identify overcharges, undercharges and unbundled items.
- Identify unbundled items on the itemized bill specific to payer Unbundling Guidelines and provide references and rationale to support review findings.
- Onsite Travel – Maintain timely communication with Audit Coordinator regarding scheduling, completion and submission of audits. Abide by the EXL Travel policy while making travel arrangements for onsite audits.
- Scheduling Audits: Manage inventory and schedule audits timely by contacting the provider to schedule date and time to perform audits.
- Report any problems in the audit process to Manager for resolution.
- Comply with HIPAA and other regulations regarding the confidentiality of patient information.
- Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs.
- Three or more years of experience in claims processing, medical billing, or auditing—with a strong focus on Durable Medical Equipment (DME).
- In-depth knowledge of HCPCS codes and reimbursement policies.
- Proven ability to read and interpret contract language and fee schedules.
- Intermediate Excel and Word skills, with a solid grasp of basic math.
Preferred Qualifications
- Preferably certified with RHIA, CPC, or similar credentials (multiple credentials are a plus).
- Bonus if you’ve used: FACETS, NASCO, Encoder Pro, TrueCode, 3M, Webstrat, Pricers.
Professional Qualifications
- Comfortable working independently in a remote environment.
- Strong written and verbal communication, time management, and analytical skills.
Salary range $70,000.00-$80,000.00.
0-10% travel may be required.
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
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 54,000 employees spanning six continents. For more information, visit www.exlservice.com.