Inpatient Rehabilitation Facility Quality Analyst – Healthcare

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $70k - $110k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 1%

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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

• Apply IRF audit, coding, reimbursement, and documentation expertise to evaluate the accuracy and consistency of completed IRF Auditor work • Perform random, targeted, follow-up, and focused quality reviews of completed IRF audits • Validate audit findings, no-findings, documentation support, coding logic, reimbursement impact, and audit rationale • Follow approved sampling methodology and quality review procedures • Apply quality scoring criteria to evaluate audit accuracy, documentation quality, client requirements, and EXL quality standards • Confirm audit determinations are supported by IRF-PAI, UB-04/final bill, medical records, therapy and physician documentation, nursing documentation, orders, MAR, pre-admission screening, plan of care, interdisciplinary documentation, CMS guidance, payer requirements, and internal procedures • Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, onset date, comorbidities, complications, treatment, and reimbursement support • Review audit documentation for clarity, completeness, grammar, evidence-based support, and communication quality • Identify documentation, coding, and reimbursement discrepancies affecting IRF payment • Provide professional feedback and coaching to IRF Auditors • Identify audit trends, recurring errors, documentation gaps, inconsistent audit logic, and process or training needs • Perform root cause analysis and recommend corrective actions • Support calibration discussions, quality monitoring, score reviews, procedure updates, and training • Write communications documenting review outcomes, findings, rationale, trends, coaching recommendations, and next steps • Maintain quality review results and reporting for monitoring, trend analysis, leadership review, coaching, and improvement • Communicate quality results, risks, trends, and recommendations to peers and management • Stay current with IRF reimbursement updates, CMS guidance, IRF-PAI manuals, ICD-10-CM/PCS updates, payer policies, and internal procedures • Perform duties in accordance with compliance, information security, HIPAA, regulatory policies, procedures, and programs

🎯 Requirements

• Minimum High School Diploma required • 5+ years of inpatient facility coding, auditing, payment integrity, reimbursement review, quality review, audit validation, or related healthcare experience preferred • Strong IRF audit, IRF coding, IRF reimbursement, IRF-PAI, or rehabilitation facility documentation review experience preferred • Strong understanding of ICD-10-CM/PCS, inpatient facility claim review, medical record abstraction, documentation validation, payer reimbursement methodologies, audit scoring expectations, and the relationship between documentation, coded data, IRF-PAI elements, and reimbursement outcomes • Experience identifying quality errors, missed opportunities, documentation gaps, inconsistent audit application, and trends in complex inpatient or IRF audit work • Experience reviewing lengthy medical records and tying documentation to reimbursement impact, treatment during the IRF stay, payer/client requirements, and audit findings • Ability to provide constructive feedback and coaching to auditors • Ability to evaluate auditor work objectively and distinguish IRF-PAI documentation requirements from traditional acute-care DRG coding logic • Strong analytical, problem-solving, root cause analysis, and critical-thinking skills • Excellent attention to detail and documentation accuracy • Excellent written and verbal communication skills • Ability to work independently in a remote environment while maintaining quality, productivity, confidentiality, and timely completion • Proficient in Excel, Word, Outlook, OneNote, and general computer applications • Commitment to teamwork, calibration, continuous learning, consistent quality application, process improvement, and accurate audit outcomes • Required knowledge of IRF Quality Review, Inpatient Rehabilitation Facility (IRF), IRF-PAI Validation, IRF PPS/HIPPS Methodology, ICD-10-CM/PCS, Medical Record Review, Audit Sampling, Quality Scoring, Documentation Validation, Root Cause Analysis, Quality Feedback, Calibration, Trend Identification, Written Communication, and HIPAA Compliance

🏖️ Benefits

• 100% remote work from home • Up to 10% annual travel for team meetings and limited client onsite engagements • Benefits information provided through EXL’s US careers and benefits program

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