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Quality Analyst, Lead Assistant Manager
EXLQuality Analyst overseeing clinical audit program for home health services at EXL. Ensuring accuracy in clinical coding audits and developing audit feedback sessions with clinical staff.
About the role
Key responsibilities & impact- 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
What you’ll need- 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
Comp & perks- For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
ATS Keywords
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Hard Skills & Tools
Clinical CodingAuditingOASIS Claims ReviewICD-10 CodingQuality ReviewMedical TerminologyHuman PhysiologyCompliance ReviewData ExtractionTraining Development
Soft Skills
Decision-MakingCommunicationMentoringOrganizational SkillsAdaptability
Certifications
OASIS CertificationCoding Certification