Quality Analyst, Lead Assistant Manager

🕒 July 2

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

• Oversees work performed by the home health clinical audit program to ensure that EXL’s standard of accuracy is met. • Undertakes quality review of random and targeted clinical coding audits, involving and consulting with clinical auditors, clinicians, and managers to enhance the accuracy and completeness of audits performed. • Develops audit feedback sessions to all staff from routine internal audit, identifying general training trends and requirements.

🎯 Requirements

• Registered Nurse with a license in good standing in the state that you reside • 7 plus years of home health experience • Previous auditing experience • OASIS certification and/or coding certification preferred • Experience, or equivalent, coding or auditing of Home Health OASIS and non-OASIS claims • Ability to review SOC/ROC/Recert assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy • Ability to ensure appropriate ICD-10 coding and sequencing as it relates 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 the overpayment • Assists the program/team in returning client overpayments and achieving internal revenue goals • 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

🏖️ Benefits

• For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits