Quality Analyst – Outpatient, Healthcare

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $85k - $92k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 1%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 30 days.

Apply Now

Find Similar Remote Jobs

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 coding auditors’ work for accuracy and consistency • Validate audit determinations, supporting documentation, and rationales against client and program expectations • Review medical records to determine facility coding accuracy • Assign root cause analysis categories and flag recurring trends to the Quality Manager • Mentor coding auditors and provide feedback • Perform quality reviews for initial audits and appeals • Manage QA inventory and meet quality, productivity, and turnaround expectations • Identify overpayment and underpayment findings and support audit reporting and trend analysis • Participate in calibration sessions for consistent review decisions and coding guidance application • Recommend process improvements • Escalate recurring errors, guideline questions, and process gaps to the Quality Manager • Stay current on CMS, payer, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifier, and ICD-10-CM updates • Perform other assigned duties • Follow company compliance, information security, and regulatory policies

🎯 Requirements

• Bachelor’s Degree • CCS, CPC, or COC certification required • CPMA, COSC, CCC, or CASCC certification preferred • Minimum 5 years coding experience • Professional or hospital coding experience • Thorough understanding of ICD-10-CM, HCPCS/CPT, OPPS, and APC • Ability to code complex outpatient services, including interventional radiology, ambulatory surgery, emergency room, and observation • Expertise in Medicare LCDs and NCDs • Expertise in NCCI edits, MUEs, and facility modifiers such as 59/XS, 73/74, and 25 • Ability to write professional notes citing recognized coding and Medicare resources • Prior coding audit, compliance review, RAC, or payer-side Payment Integrity audit experience preferred • Experience reviewing operative reports for complex surgical procedures preferred • Excellent verbal, written, and interpersonal communication skills • Strong organizational skills, attention to detail, and accuracy • Ability to work independently and in a team environment • Flexibility and adaptability • Superior coding audit and monitoring skills • Excellent decision-making and sound judgment • Strong technical knowledge and ability to learn new systems quickly • Ability to complete tasks efficiently, resolve problems, and meet deadlines • Proficiency in Microsoft Excel, PowerPoint, Outlook, and Word

🏖️ Benefits

• Exciting, fast-paced, and innovative work environment • Opportunity to work closely with experienced healthcare consultants • Exposure to multiple aspects of clients’ businesses • Teamwork and time-management skill development • Mentoring program with a senior-level professional advisor for junior-level employees • Career growth and development opportunities

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume