Quality Analyst – Skilled Nursing Facility, Patient-Driven Payment Model

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

📋 Description

• Perform quality assessments of finalized audits

• Ensure adherence to CMS regulations, internal policies, client requirements, and audit methodologies

• Assess the precision, consistency, and justification of audit conclusions

• Recognize trends and opportunities for process enhancements

• Contribute to overall quality performance and operational excellence

⛳️ Requirements

• Active Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license in good standing within your state

• Over 5 years of experience in SNF clinical settings, MDS 3.0 completion, PDPM reimbursement methodology, quality assurance, auditing, or similar fields

• In-depth understanding of MDS 3.0 coding guidelines, skilled nursing facility (SNF) care levels, and PDPM reimbursement

• Prior experience or exposure to the billing of HIPPS codes

• Proficient in reviewing audit findings, conducting quality revisions, or performing compliance monitoring activities

• Familiarity with: Excel, PowerPoint, Outlook, and Word

• Experience using Encoder tools such as 3M

• Knowledge and expertise in Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)

• Must possess strong attention to detail

• Must demonstrate excellent verbal and written communication abilities

• Must be self-motivated and capable of working with minimal supervision

🏝️ Benefits

• For additional details regarding benefits and our offerings, please visit us at https://www.exlservice.com/us-careers-and-benefits