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Quality Analyst – Skilled Nursing Facility, Patient-Driven Payment Model
EXLQuality Analyst in a remote role conducting quality reviews for SNF/PDPM audits. Ensuring compliance with CMS regulations and identifying improvement opportunities.
About the role
Key responsibilities & impact- Conduct quality reviews of completed audits
- Ensure compliance with CMS regulations, internal policies client requirements, and audit methodologies
- Evaluate the accuracy, consistency, and defensibility of audit determinations
- Identify trends and process improvement opportunities
- Contribute to overall quality performance and operational excellence
Requirements
What you’ll need- Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license in good standing in the state that you reside
- 5 plus years’ experience with SNF clinical, MDS 3.0 completion, PDPM reimbursement methodology, quality assurance, auditing, and/or related experience
- Advanced knowledge of MDS 3.0 coding guidelines, skilled nursing facility (SNF) levels of care, and PDPM reimbursement
- Previous experience/exposure to the billing of HIPPS codes
- Experience reviewing audit findings, conducting quality revises, or performing compliance monitoring activities
- Experience with: Excel, PowerPoint, Outlook, and Word
- Experience with Encoder tools such as 3M
- Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)
- Must be detail oriented
- Must have excellent verbal and written communication skills
- Must be self-directed and able to work with minimum oversight
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
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
MDS 3.0 Coding GuidelinesQuality ReviewAudit Determinations EvaluationCompliance MonitoringHIPPS Codes Billing
Soft Skills
Detail OrientedExcellent Verbal CommunicationExcellent Written CommunicationSelf-Directed
Certifications
Licensed Practical NurseLicensed Vocational Nurse