Quality Analyst, Lead Assistant Manager

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

📋 Description

• Evaluate the precision and uniformity of clinical auditors to guarantee audits are correctly marked for findings and non-findings.

• Support the mentoring of clinical auditors.

• Suggest process improvements to enhance quality and performance.

• Conduct root cause analysis on errors.

• Update training materials and user manuals.

• Engage in communication with colleagues and management.

• Meet productivity and quality targets.

• Respond promptly to emails and meeting requests, and actively participate in discussions.

• Take part in ongoing improvement and educational activities.

• Attend mandatory or self-initiated training to boost performance or address new overpayment trends.

• Stay informed about CMS, OIG, and other relevant publications related to the business.

• Assist the program/team in recovering client overpayments and meeting internal revenue targets.

• Perform additional duties as assigned.

⛳️ Requirements

• Registered Nurse with an active license in good standing in your state of residence.

• Over 7 years of experience in home health.

• Prior experience in auditing.

• Experience or equivalent in coding or auditing Home Health OASIS and non-OASIS claims.

• OASIS certification and/or coding certification is preferred.

• Capability to review SOC/ROC/Recert assessments for suitability, completeness, and adherence to federal and state regulations and organizational policy.

• Ability to ensure correct ICD-10 coding and sequencing in relation to the patient’s medical condition.

• Familiarity with CMS/Chapter 7 Home Health Coverage Guidelines, National Coverage Guidelines, and HH PPS Reimbursement.

• Skill in identifying, extracting, and utilizing record information to address issues related to overpayment.

• Exceptional clinical auditing and monitoring abilities.

• Strong decision-making skills and sound judgment.

• Comprehensive understanding of medical terminology and human physiology.

• Strong technical aptitude and the ability to quickly learn new systems.

• Excellent verbal and written communication skills.

• Capacity to mentor and instruct through audits.

• Strong organizational skills with a keen attention to detail.

• Proven flexibility and adaptability.

• Ability to work collaboratively in a team environment as well as independently when required.

• Proficient in Microsoft Excel.

🏝️ Benefits

• Base salary ranging from $60,100 to $98,700.

• Opportunity for bonuses.

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

• Option for remote work from home.