• Review professional claims to verify HCPCS coding accuracy and appropriate reimbursement for Durable Medical Equipment (DME). • Apply industry knowledge and EXL’s proprietary tools to identify overpayments and audit trends. • Write clear, professional audit rationales based on AMA guidelines. • Navigate various client systems to reprice and process complex claims. • Interpret provider contracts and fee schedules to determine correct payment methods. • Maintain high standards for quality, productivity, and appeals uphold rate. • Stay updated on coding guidelines, CMS/OIG policies, and industry best practices. • Ensure compliance with HIPAA and all federal/state regulations.