Quality Analyst, Lead Assistant Manager

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

💰 $2M Venture Round on 2015-01

Choosing a digital partner is about more than capabilities — it’s about collaboration and character.

📋 Description

• Oversees work performed by the home health clinical audit program to ensure that EXL’s standard of accuracy is met. • Undertakes quality review of random and targeted clinical coding audits, involving and consulting with clinical auditors, clinicians, and managers to enhance the accuracy and completeness of audits performed. • Develops audit feedback sessions to all staff from routine internal audit, identifying general training trends and requirements.

🎯 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 • OASIS certification and/or coding certification preferred • Experience, or equivalent, coding or auditing of Home Health OASIS and non-OASIS claims • Ability to review SOC/ROC/Recert assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy • Ability to ensure appropriate ICD-10 coding and sequencing as it relates 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 the overpayment • Assists the program/team in returning client overpayments and achieving internal revenue goals • 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

• For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits