• Apply your expert knowledge of billing HCD claims to perform extensive audit reviews. • Utilize HCPCS codes, medical record review, industry and EXL proprietary tools in the audit process. • Write professional communications documenting audit findings and supporting rationales. • Apply your extensive industry knowledge to identify audit trends and opportunities. • Conduct HCPCS coding reviews to verify the accuracy of the coding assignment and reimbursement on high cost drug professional and outpatient facility claims. • Apply complex medical record reviews to identify discrepancies between physician orders, nursing administration logs, and final claims submissions. • Apply Medicare, Medicaid, and commercial guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications. • Document audit results in a clear, concise, and effective manner using AMA Guidelines. • Utilize proprietary workflow systems to make audit determinations, generate audit rationales, and move claims through workflow process correctly efficiently and accurately. • Accurately reprice complex claims utilizing multiple client claims systems. • Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals. • Research prescribed drug dosage and related conditions to ensure appropriateness of medical guidelines and accuracy of reimbursement. • Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.