Teams at EXL

Perform and complete inpatient DRG audits per SOP, meet quality and production targets, follow project protocols, escalate issues, update daily logs, consult managers for clarifications, ensure team HIPAA and OIG compliance, and maintain prompt communication and accurate records.

Perform high-volume outbound calls to US insurers, providers, and TPAs to resolve denied or pending claims, document interactions, correct denials, meet productivity and quality targets, and ensure HIPAA/OIG compliance while coordinating with internal teams and updating management on claim status.

Reviews medical claims against patient records to validate diagnoses, procedures, documentation, coding, and billed services. Identifies discrepancies, compliance issues, documentation gaps, and revenue leakage, then prepares audit findings and corrective recommendations. Collaborates with coding, billing, and provider teams, monitors recurring trends, supports quality assurance, follows CMS and payer requirements, and meets audit accuracy and productivity targets.