Outpatient Quality Manager

Job not on LinkedIn

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $100k - $120k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 4%

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

• Drive execution and ongoing improvement of outpatient coding quality review programs, including initial audits, appeals, targeted reviews, provider- or concept-specific reviews, and ATA audits • Manage day-to-day outpatient quality review operations, including workflow distribution, inventory, QA aging, productivity, timeliness, client SLAs, quality expectations, and internal standards • Provide direct supervision to outpatient quality analysts through coaching, feedback, performance management, one-on-ones, training, development planning, and upskilling • Analyze audit accuracy, productivity, QA inventory, defect trends, root causes, auditor performance, documentation patterns, and quality metrics to improve team performance and quality results • Perform ATA audits and ensure determinations, documentation support, rationales, and outcomes are accurate and consistent • Ensure RCA categories are marked appropriately and recurring trends receive follow-up, coaching, clarification, process correction, or escalation • Lead regular calibration with outpatient quality analysts • Partner with Operations, Training, Technology, clients, and global partners to resolve issues and support audit quality solutions • Support program implementations and operational initiatives by defining quality expectations, review criteria, sampling approaches, workflow needs, reporting requirements, and quality controls • Identify responsible AI-in-the-workflow opportunities while maintaining human review, compliance, and data security • Monitor CMS, payer, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifier, and ICD-10-CM guideline updates • Perform all responsibilities in accordance with Compliance, Information Security, and Regulatory policies

🎯 Requirements

• CCS, CPC, RHIT, RHIA, or other relevant coding credential required; CCS or CPC preferred • Minimum 5 years of outpatient facility coding, auditing, or quality review experience • Understanding of ICD-10-CM, CPT, HCPCS, modifiers, OPPS, APC reimbursement, and outpatient payment methodologies • Prior leadership, supervisory, quality management, or team lead experience required • Experience applying Medicare LCDs, NCDs, NCCI edits, payer policies, and medical necessity requirements • Experience with outpatient audit operations, quality assurance, root cause analysis, coaching, and performance improvement • Strong outpatient coding expertise across complex facility services • Proficiency in modifier application, CPT/HCPCS coding, ICD-10-CM coding, NCCI edits, MUEs, and Medicare/payer-specific guidelines • Ability to evaluate audit accuracy and validate findings, no-findings, rationales, documentation, and coding guidance • Ability to write professional quality notes citing Official Coding Guidelines, Coding Clinic, AMA CPT Assistant, CMS guidance, LCD/NCD policies, and other recognized sources • Leadership, coaching, mentoring, verbal communication, written communication, analytical, root cause analysis, decision-making, problem-solving, organizational, and attention-to-detail skills • Ability to manage competing priorities, inventory, and deadlines • Ability to work independently and collaboratively with Operations, Training, Technology, clients, and global partners • Flexibility, adaptability, accountability, and sound judgment in a fast-paced audit environment • Technical knowledge and ability to learn audit tools, reporting platforms, and workflow systems • Ability to leverage approved AI-enabled tools and workflow technology • Proficiency with Excel, PowerPoint, Outlook, Word, and audit productivity/reporting tools

🏖️ Benefits

• Exciting, fast-paced, and innovative environment • Opportunity to work closely with experienced, world-class Healthcare consultants • Opportunities to learn multiple aspects of clients’ businesses • Mentoring program with guidance/coaching from senior-level professionals • Opportunities for personal and professional growth • Opportunities for further growth and development within the company and beyond • Limited travel may be required for team meetings • Remote work from home