Quality Analyst

🕒 March 26

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

💰 $2M Venture Round on 2015-01

Choosing a digital partner is about more than capabilities — it’s about collaboration and character.

📋 Description

• The Quality Analyst IV oversees work performed by the Outpatient audit program to ensure that EXL’s standard of accuracy is met. • Audits are performed by validating the accuracy of the coding billed in relation to the medical documentation. • The coding auditor determines if a discrepancy exists in the coding and documents the findings. • The quality analyst undertakes a quality review of random and targeted coding audits to check the accuracy and completeness of audits performed. • Responsible for reviewing the accuracy and consistency of coding auditors to ensure audits are appropriately marked for findings and no findings. • Provide root cause analysis on errors. • Mentor outpatient coders and provide feedback when required. • Perform quality reviews for initial audits and appeals. • Identify potential opportunities outside of the concept for additional recoveries. • Recommend process changes to improve quality and performance. • Communicate with peers and management. • Perform other duties as assigned.

🎯 Requirements

• CCS or CPC certified • Minimum 5 years coding experience: Professional or hospital coding with thorough understanding of ICD-10 Coding; HCPCS/CPT coding systems; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC) • Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD) • Must have the ability to code a wide variety of complex outpatient services such as interventional radiology, ambulatory surgery, emergency room and observation. • Reviews medical records to determine if facility coding is accurate. • Proficient in modifier application following appropriate Medicare and NCCI guidelines. • Ability to write professional notes quoting resources of Official Coding guidelines, ICD-10 Coding Handbook, Coding Clinic and/or other recognized sources. • Excellent verbal and written communication skills. • Ability to mentor and instruct through audits. • Strong organizational skills and attention to detail. • Ability to work in a team environment and independently as needed. • Demonstrate flexibility and adaptability. • Superior clinical auditing and monitoring skills. • Excellent decision-making skills and sound judgment. • Strong technical knowledge and ability to learn new systems quickly. • Ability to complete tasks efficiently and resolve problems within set timelines. • Must be able to work under deadlines. • Personal computer skills required. • Experience with: Excel, PowerPoint, Outlook, and Word. • Strong interpersonal skills required.

🏖️ Benefits

• EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. • From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants. • You can expect to learn many aspects of businesses that our clients engage in. • You will also learn effective teamwork and time-management skills—key aspects for personal and professional growth. • We provide guidance/coaching to every employee through our mentoring program wherein every junior-level employee is assigned a senior-level professional as an advisor. • The sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond.