Inpatient Rehabilitation Facility Quality Analyst – Healthcare

This is a fully remote position, open to applicants in United States.

📋 Description

• Utilize expertise in IRF auditing, coding, reimbursement, and documentation to assess the accuracy and consistency of completed work by IRF Auditors.

• Conduct random, targeted, follow-up, and focused quality reviews of finalized IRF audits.

• Verify audit findings, no-findings, documentation support, coding logic, reimbursement impact, and the rationale behind audits.

• Adhere to approved sampling methodologies and quality review protocols.

• Apply quality scoring criteria to assess audit accuracy, documentation quality, client needs, and EXL quality standards.

• Ensure audit conclusions are substantiated by IRF-PAI, UB-04/final bill, medical records, therapy and physician documentation, nursing documentation, orders, MAR, pre-admission screening, plan of care, interdisciplinary documentation, CMS guidelines, payer requirements, and internal procedures.

• Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, onset date, comorbidities, complications, treatment, and reimbursement support.

• Evaluate audit documentation for clarity, completeness, grammar, evidence-based support, and quality of communication.

• Identify discrepancies in documentation, coding, and reimbursement that may impact IRF payment.

• Offer professional feedback and coaching to IRF Auditors.

• Recognize audit trends, recurring errors, documentation gaps, inconsistent audit logic, and areas requiring process or training improvements.

• Execute root cause analyses and suggest corrective actions.

• Assist with calibration discussions, quality monitoring, score reviews, procedure updates, and training sessions.

• Compose communications that document review outcomes, findings, rationale, trends, coaching recommendations, and subsequent steps.

• Maintain quality review results and reporting for monitoring, trend analysis, leadership oversight, coaching, and enhancement.

• Convey quality results, risks, trends, and recommendations to peers and management.

• Stay updated with IRF reimbursement changes, CMS guidance, IRF-PAI manuals, ICD-10-CM/PCS updates, payer policies, and internal procedures.

• Perform tasks in alignment with compliance, information security, HIPAA, regulatory policies, procedures, and programs.

⛳️ Requirements

• A minimum of a High School Diploma is required.

• Preferred: 5+ years of experience in inpatient facility coding, auditing, payment integrity, reimbursement review, quality review, audit validation, or related healthcare roles.

• Preferred: Strong experience in IRF auditing, IRF coding, IRF reimbursement, IRF-PAI, or rehabilitation facility documentation review.

• Comprehensive understanding of ICD-10-CM/PCS, inpatient facility claim review, medical record abstraction, documentation validation, payer reimbursement methodologies, audit scoring expectations, and the interplay between documentation, coded data, IRF-PAI elements, and reimbursement outcomes.

• Experience in identifying quality errors, missed opportunities, documentation gaps, inconsistencies in audit application, and trends in complex inpatient or IRF audit activities.

• Experience in reviewing extensive medical records and correlating documentation to reimbursement impact, treatment during the IRF stay, payer/client requirements, and audit findings.

• Capability to provide constructive feedback and coaching to auditors.

• Ability to objectively assess auditor work and differentiate IRF-PAI documentation requirements from traditional acute-care DRG coding logic.

• Strong analytical, problem-solving, root cause analysis, and critical-thinking abilities.

• Exceptional attention to detail and accuracy in documentation.

• Excellent written and verbal communication skills.

• Ability to work independently in a remote setting while ensuring quality, productivity, confidentiality, and timely completion.

• Proficient in Excel, Word, Outlook, OneNote, and general computer applications.

• Commitment to teamwork, calibration, continuous learning, consistent quality application, process enhancement, and accurate audit results.

• Required knowledge of IRF Quality Review, Inpatient Rehabilitation Facility (IRF), IRF-PAI Validation, IRF PPS/HIPPS Methodology, ICD-10-CM/PCS, Medical Record Review, Audit Sampling, Quality Scoring, Documentation Validation, Root Cause Analysis, Quality Feedback, Calibration, Trend Identification, Written Communication, and HIPAA Compliance.

🏝️ Benefits

• Work 100% remotely from home.

• Up to 10% annual travel for team meetings and limited client onsite engagements.

• Benefits information is provided through EXL’s US careers and benefits program.