Quality Analyst IV – Healthcare

🔥 4 minutes ago

🇺🇸 United States – Remote

💵 $70k - $110k / 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

• 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 standards • Confirm IRF audit determinations are supported by the IRF-PAI, UB-04/final bill, discharge summary, complete IRF medical record, therapy and physician documentation, nursing notes, MAR, pre-admission screening, plan of care, interdisciplinary team documentation, CMS guidance, payer requirements, and internal procedures • Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, date of onset, comorbid conditions, complication/comorbidity reporting, treatment received, and reimbursement support • Review audit documentation for clarity, completeness, grammar, evidence-based support, and quality expectations • Identify documentation, coding, and reimbursement discrepancies affecting IRF payment • Provide professional feedback and coaching to IRF Auditors, including corrections and improvement opportunities • 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, SOP updates, and training opportunities • Write communications documenting quality outcomes, findings, rationale, trends, coaching recommendations, and next steps • Maintain quality review results and reporting for performance monitoring, trend analysis, leadership review, and quality improvement • Communicate quality results, risks, trends, and recommendations to peers and management • Stay current with IRF reimbursement updates, CMS guidance, IRF-PAI manual updates, ICD-10-CM/PCS updates, payer policies, and internal procedures • Perform responsibilities in accordance with company compliance, information security, HIPAA, and regulatory policies

🎯 Requirements

• Minimum High School Diploma required • Associate’s or bachelor’s degree in Health Information Management, healthcare administration, nursing, rehabilitation services, or a related healthcare field preferred • CCS, RHIA, RHIT, CIC, CPC, or comparable coding credential preferred; multiple coding credentials strongly preferred • 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 strongly 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, specific, and actionable feedback 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 with excellent attention to detail • 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 • Experience with audit workflow tools, coding references, encoder tools, and medical record review platforms preferred • Commitment to teamwork, calibration, continuous learning, process improvement, and accurate audit outcomes • HIPAA compliance

🏖️ Benefits

• Up to 10% annual travel for team meetings and limited client onsite engagements • Benefits information provided via EXL US Careers and Benefits • Remote work from home