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Behavioral Health Quality Analyst
EXLBehavioral Health Quality Analyst auditing coding, billing, and documentation for EXL, a data analytics and digital operations company. Reviewing trends, coaching auditors, and improving healthcare audit quality.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in Behavioral Health auditing, quality reviews, and compliance, with a strong focus on mentoring and process improvement. Proficient in coding, billing, and documentation standards relevant to mental health and substance use disorder treatment.
Highest-signal resume keywords
Behavioral Health AuditingQuality ReviewRoot Cause AnalysisMentoring AuditorsBehavioral Health Coding
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Behavioral Health CodingQuality ReviewRoot Cause AnalysisModifier ApplicationDocumentation Requirements
Soft Skills
Excellent Verbal CommunicationExcellent Written CommunicationConstructive Feedback
Tools & Technologies
Microsoft ExcelMicrosoft PowerPointMicrosoft OutlookMicrosoft Word
Certifications & Qualifications
CCSRHIARHITCPCRegistered NurseMSW
Industry Keywords
Behavioral Health ServicesMental HealthSubstance Use Disorder TreatmentPayer RequirementsRegulatory Guidance
About the role
Key responsibilities & impact- Review the accuracy and consistency of Behavioral Health auditors’ work and audit classifications
- Perform random and targeted quality reviews of Behavioral Health audits
- Verify findings and no-findings against medical record documentation and applicable guidance
- Conduct root cause analyses of errors, quality trends, and missed opportunities
- Mentor auditors and provide timely, constructive feedback
- Review initial audits, appeals, and other assigned audit work
- Identify and escalate potential recovery opportunities
- Recommend process improvements to enhance quality, consistency, documentation, and performance
- Communicate quality results, trends, concerns, and recommendations to peers and management
- Perform duties in accordance with compliance, information security, and regulatory policies
Requirements
What you’ll need- Minimum of five years of experience with Behavioral Health services, including mental health and substance use disorder treatment
- One or more of the following credentials preferred: CCS, RHIA, RHIT, CPC, Registered Nurse, or MSW
- Strong knowledge of Behavioral Health coding, billing, clinical documentation, payer requirements, and regulatory guidance
- Experience with retrospective Behavioral Health audits preferred
- Experience with quality reviews, secondary reviews, peer reviews, or audit validation preferred
- Experience identifying quality trends, conducting root cause analyses, and recommending corrective actions
- Experience mentoring auditors and providing feedback preferred
- Knowledge of modifier application, documentation requirements, payer policies, Medicare, and NCCI guidelines
- Ability to write audit notes supported by Official Coding Guidelines, the ICD-10 Coding Handbook, Coding Clinic, payer policies, and other references
- Excellent verbal and written communication skills
- Advanced Behavioral Health auditing and quality monitoring skills
- Strong technical aptitude and ability to learn new systems quickly
- Proficiency with Microsoft Excel, PowerPoint, Outlook, and Word
Benefits
Comp & perks- 100% 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
- Opportunities for advancement
- Opportunities to grow career and expand skills