Quality Analyst, Lead Assistant Manager

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $60.1k - $98.7k / year

⏰ Full Time

🟠 Senior

🧐 Analyst

👻 Ghost score 3%

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 clinical auditors to ensure audits are appropriately marked for findings and no findings • Assist in mentoring clinical auditors • Recommend process changes to improve quality and performance • Provide root cause analysis on errors • Provide updates to training and user manuals • Communicate with peers and management • Achieve productivity and quality goals • Respond timely to emails and meeting requests and actively participate in discussions • Participate in continuous improvement and education activities • Attend assigned or self-initiated training to improve performance or capitalize on new overpayment trends • Keep up with CMS, OIG, and other publications related to the business • Assist the program/team in returning client overpayments and achieving internal revenue goals • Perform other duties as assigned

🎯 Requirements

• Registered Nurse with a license in good standing in the state that you reside • 7 plus years of home health experience • Previous auditing experience • Experience, or equivalent, coding or auditing Home Health OASIS and non-OASIS claims • OASIS certification and/or coding certification preferred • Ability to review SOC/ROC/Recert assessments for appropriateness, completeness, and compliance with federal and state regulations and organization policy • Ability to ensure appropriate ICD-10 coding and sequencing related to the patient’s medical condition • Knowledge of CMS/Chapter 7 Home Health Coverage Guidelines, National Coverage Guidelines, and HH PPS Reimbursement • Ability to pinpoint, extract, and use record information to cite issues related to overpayment • Superior clinical auditing and monitoring skills • Excellent decision-making skills and sound judgement • Thorough understanding of medical terminology and human physiology • Strong technical knowledge and ability to learn new systems quickly • Excellent verbal and written communication skills • Ability to mentor and instruct through audits • Strong organizational skills and high attention to detail • Demonstrated flexibility and adaptability • Ability to work in a team environment and independently as needed • Working knowledge of Microsoft Excel

🏖️ Benefits

• Base salary of $60,100–$98,700 • Bonus opportunity • Benefits information available through EXL’s US careers and benefits program • Remote work from home