Behavioral Health Quality Analyst

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $60.1k - $98.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 2%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Review the accuracy and consistency of Behavioral Health auditors’ work and classifications • Perform random and targeted quality reviews of Behavioral Health audits • Verify findings and no-findings against medical record documentation and applicable guidance • Conduct root cause analyses of errors, quality trends, and missed opportunities • Mentor Behavioral Health auditors and provide timely, constructive feedback • Review initial audits, appeals, and other assigned audit work • Identify and escalate potential recovery opportunities outside assigned audit concepts • Recommend process improvements for quality, consistency, documentation standards, and performance • Communicate quality results, trends, concerns, and recommendations to peers and management • Perform duties in accordance with company compliance, information security, and regulatory policies

🎯 Requirements

• Minimum of five years of experience with Behavioral Health services, including mental health and substance use disorder treatment • One or more of the following credentials preferred: CCS, RHIA, RHIT, CPC, Registered Nurse, or MSW • Strong knowledge of Behavioral Health coding, billing, clinical documentation, payer requirements, and applicable regulatory guidance • Prior experience conducting retrospective Behavioral Health audits to identify overpayments preferred • Experience performing quality reviews, secondary reviews, peer reviews, or audit validation for coding or clinical audit teams preferred • Experience identifying quality trends, conducting root cause analyses, and recommending corrective actions • Experience mentoring auditors and providing feedback based on quality review results preferred • Ability to review Behavioral Health medical records and determine whether audit findings are accurate, complete, and appropriately supported • Knowledge of Behavioral Health coding, billing, modifier application, documentation requirements, payer policies, Medicare, and NCCI guidelines • Ability to write clear, professional audit notes using Official Coding Guidelines, the ICD-10 Coding Handbook, Coding Clinic, payer policies, and other applicable references • Ability to mentor auditors and provide instruction through quality reviews and audit feedback • Advanced Behavioral Health auditing and quality monitoring skills • Strong technical aptitude and ability to learn new systems quickly • Proficiency with Microsoft Excel, PowerPoint, Outlook, and Word • Ability to work independently and in a team environment • Ability to complete tasks efficiently and work effectively under deadlines

🏖️ Benefits

• Remote work flexibility • Up to 10% annual travel for team meetings and limited client onsite engagements • Opportunities for growth and mentorship through a structured coaching program • Collaborative culture where ideas and insights are valued • Real opportunities for advancement • Fast-paced, innovative work environment • Opportunity to impact healthcare delivery nationwide