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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical auditing and coding within home health, ensuring compliance with federal and state regulations while mentoring clinical auditors. Proficient in root cause analysis, training development, and maintaining high standards of accuracy and performance.
Highest-signal resume keywords
Registered Nurse LicenseHome Health ExperienceClinical Auditing SkillsOASIS CertificationICD-10 Coding Knowledge
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AuditingCoding AuditingOASIS CodingICD-10 CodingRoot Cause AnalysisTraining DevelopmentRegulatory ComplianceMedical TerminologyHuman PhysiologyData Analysis
Soft Skills
Decision-MakingCommunication SkillsOrganizational SkillsFlexibilityTeam Collaboration
Tools & Technologies
Microsoft Excel
Certifications & Qualifications
OASIS CertificationCoding Certification
Industry Keywords
CMS GuidelinesHome Health Coverage GuidelinesHH PPS ReimbursementSOC/ROC/Recert AssessmentsAudit Feedback Sessions
About the role
Key responsibilities & impact- Oversee work performed by the home health clinical audit program to ensure EXL’s accuracy standards are met
- Review random and targeted clinical coding audits
- Consult with clinical auditors, clinicians, and managers to enhance audit accuracy and completeness
- Develop audit feedback sessions for all staff based on routine internal audits
- Identify general training trends and requirements
- Review clinical auditors’ accuracy and consistency 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
- Update training and user manuals
- Communicate with peers and management
- Achieve productivity and quality goals
- Participate in continuous improvement and education activities
- Attend assigned or self-initiated training and monitor CMS, OIG, and other relevant publications
- Perform other duties as assigned
Requirements
What you’ll need- Registered Nurse with a license in good standing in the state that you reside
- 7 years home health experience
- Previous auditing experience
- OASIS certification and/or coding certification preferred but not mandatory
- Experience, or equivalent, coding or auditing Home Health OASIS and non-OASIS claims
- 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
Comp & perks- Remote work flexibility
- Up to 10% annual travel for team meetings and limited client onsite engagements
- Opportunities for growth and mentorship through a structured coaching program
- Collaborative culture where ideas and insights are valued
- Real opportunities for advancement
- Fast-paced, innovative environment with a team of sharp, driven professionals