Quality Analyst, Lead Assistant Manager

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

📋 Description

• Manages the activities conducted by the home health clinical audit program to ensure adherence to EXL’s accuracy standards.

• Performs quality assessments of both random and targeted clinical coding audits, collaborating with clinical auditors, clinicians, and managers to improve the precision and thoroughness of the audits conducted.

• Creates feedback sessions for all staff based on routine internal audits, identifying overall training trends and needs.

⛳️ Requirements

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

• Over 7 years of experience in home health care.

• Prior experience in auditing.

• OASIS certification and/or coding certification is preferred.

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

• Capability to review SOC/ROC/Recert assessments to ensure they meet appropriateness, completeness, and compliance with federal and state regulations as well as organizational policies.

• Ability to ensure correct ICD-10 coding and sequencing related to the patient's medical condition.

• Knowledge of 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 concerning overpayment.

• Supports the program/team in recovering client overpayments and meeting internal revenue objectives.

• Exceptional clinical auditing and monitoring abilities.

• Strong decision-making capabilities and sound judgment.

• Comprehensive understanding of medical terminology and human physiology.

• Advanced technical knowledge and the ability to quickly learn new systems.

• Excellent verbal and written communication skills.

• Ability to mentor and guide others through audits.

• Strong organizational abilities and meticulous attention to detail.

• Proven adaptability and flexibility.

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

• Proficient in Microsoft Excel.

🏝️ Benefits

• For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits.