Quality Analyst, Lead Assistant Manager

🕒 6 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $60.100 - $98.700 / ano

⏰ Tempo Integral

🟠 Sênior

🧐 Analista

👻 Score fantasma 2%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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EXL

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

🛡️ Seguros

📦 Logística

💰 $2.000.000 Venture Round em 2015-01

Healthcare • Insurance • Logistics

Escolher um parceiro digital vai além das capacidades — trata-se de colaboração e caráter.

Descrição

• Review the accuracy and consistency of clinical auditors to ensure audits are appropriately marked for findings and no findings • Assist in mentoring clinical auditors • Recommend process changes to improve quality and performance • Provide root cause analysis on errors • Provide updates to training and user manuals • Communicate with peers and management • Achieve productivity and quality goals • Respond timely to emails and meeting requests and actively participate in discussions • Participate in continuous improvement and education activities • Attend assigned or self-initiated training to improve performance or capitalize on new overpayment trends • Keep up with CMS, OIG, and other publications related to the business • Assist the program/team in returning client overpayments and achieving internal revenue goals • Perform other duties as assigned

🎯 Requisitos

• Registered Nurse with a license in good standing in the state that you reside • 7 plus years of home health experience • Previous auditing experience • Experience, or equivalent, coding or auditing Home Health OASIS and non-OASIS claims • OASIS certification and/or coding certification preferred • Ability to review SOC/ROC/Recert assessments for appropriateness, completeness, and compliance with federal and state regulations and organization policy • Ability to ensure appropriate ICD-10 coding and sequencing related to the patient’s medical condition • Knowledge of CMS/Chapter 7 Home Health Coverage Guidelines, National Coverage Guidelines, and HH PPS Reimbursement • Ability to pinpoint, extract, and use record information to cite issues related to overpayment • Superior clinical auditing and monitoring skills • Excellent decision-making skills and sound judgement • Thorough understanding of medical terminology and human physiology • Strong technical knowledge and ability to learn new systems quickly • Excellent verbal and written communication skills • Ability to mentor and instruct through audits • Strong organizational skills and high attention to detail • Demonstrated flexibility and adaptability • Ability to work in a team environment and independently as needed • Working knowledge of Microsoft Excel

🏖️ Benefícios

• Base salary of $60,100–$98,700 • Bonus opportunity • Benefits information available through EXL’s US careers and benefits program • Remote work from home