Home Health Auditor
EXL
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
Salary
💰 $70,000 - $80,000 per year
About the role
- Conduct Home Health reviews to verify the accuracy of the billed services based on CMS guidelines.
- Apply CMS guidelines during medical record review to ensure services provided are supported. In addition, utilize industry and proprietary tools to maximize overpayment identifications.
- Document audit results in a clear, concise, and effective manner using CMS Home Health, Oasis and ICD-10 CM Guidelines.
- Utilize proprietary workflow systems and encoder tools (e.g., Decision Health, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
- Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
- Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.
- Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.
Requirements
- Extensive knowledge of PDGM and PPS payment methodologies.
- Experience with encoder tools (Decision Health, ICD-10, Webstrat).
- Works independently in a remote environment and delivers exceptional results during EXL core business hours.
- Possesses excellent time management and work prioritization skills.
- Takes ownership of problem solving.
- Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
- Proficient in Excel, Word, and OneNote with general computer literacy.
- LPN, Registered Nurse with Associate's or Bachelor's degree preferred
- 3+ years of acute care nursing experience with preference given to candidates with OASIS or Coding Certification.
- Prior Home Health auditing experience.
Benefits
- For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
PDGMPPSICD-10OASISauditingmedical record reviewoverpayment identificationtime managementproblem solvinganalytical skills
Soft Skills
written communicationverbal communicationattention to detailwork prioritizationindependence
Certifications
LPNRegistered NurseCoding Certification