Quality Analyst, Trainer – Home Health

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

📋 Description

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

• Conduct reviews of both random and targeted clinical coding audits.

• Collaborate with clinical auditors, clinicians, and managers to improve the accuracy and thoroughness of audits.

• Create audit feedback sessions for all personnel based on regular internal audits.

• Identify overall training trends and requirements.

• Evaluate the accuracy and consistency of clinical auditors to ensure audits are properly documented for both findings and non-findings.

• Assist in the mentorship of clinical auditors.

• Suggest process modifications to enhance quality and performance.

• Provide root cause analysis for any errors identified.

• Revise training and user manuals as necessary.

• Maintain communication with colleagues and management.

• Meet productivity and quality objectives.

• Engage in continuous improvement and educational initiatives.

• Attend mandatory or self-directed training and keep up with CMS, OIG, and other pertinent publications.

• Carry out additional duties as assigned.

⛳️ Requirements

• Must be a Registered Nurse with a valid license in good standing in your state of residence.

• Minimum of 7 years of experience in home health care.

• Prior experience in auditing is required.

• OASIS certification and/or coding certification is preferred but not essential.

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

• Capability to assess SOC/ROC/Recert evaluations for appropriateness, completeness, and compliance with federal and state regulations as well as organizational policies.

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

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

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

• Exceptional clinical auditing and monitoring capabilities.

• Strong decision-making skills and sound judgment.

• Comprehensive understanding of medical terminology and human physiology.

• Advanced technical knowledge and a quick learner of new systems.

• Excellent verbal and written communication abilities.

• Ability to mentor and guide others through the auditing process.

• Strong organizational skills with meticulous attention to detail.

• Proven flexibility and adaptability in various situations.

• Ability to function effectively in both team environments and independently as required.

• Proficient in Microsoft Excel.

🏝️ Benefits

• Flexibility to work remotely.

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

• Opportunities for personal growth and mentorship through a well-structured coaching program.

• A collaborative culture that values ideas and insights.

• Genuine opportunities for career advancement.

• A fast-paced, innovative environment with a team of skilled and driven professionals.