This is a remote office opportunity. The Quality Analyst IV oversees work performed by the Outpatient audit program to ensure that EXL’s standard of accuracy is met. Audits are performed by validating the accuracy of the coding billed in relation to the medical documentation. The coding auditor determines if a discrepancy exists in the coding and documents the findings. The quality analyst undertakes a quality review of random and targeted coding audits to check the accuracy and completeness of audits performed.
A brief coding/auditing assessment may be included as part of the interview process
Responsibilities
- Responsible for reviewing the accuracy and consistency of coding auditors to ensure audits are appropriately marked for findings and no findings.
- Provide root cause analysis on errors
- Mentor outpatient coders and provide feedback when required
- Perform quality reviews for initial audits and appeals
- Identify potential opportunities outside of the concept for additional recoveries.
- Recommend process changes to improve quality and performance
- Communicate with peers and management
- Perform other duties as assigned
- Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs
Qualifications
- CCS or CPC certified
- Minimum 5 years coding experience: Professional or hospital coding with thorough understanding of ICD-10 Coding; HCPCS/CPT coding systems; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC)
- Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)
Knowledge and Skills:
- Must have the ability to code a wide variety of complex outpatient services such as interventional radiology, ambulatory surgery, emergency room and observation. Reviews medical records to determine if facility coding is accurate.
- Proficient in modifier application following appropriate Medicare and NCCI guidelines
- Ability to write professional notes quoting resources of Official Coding guidelines, ICD-10 Coding Handbook, Coding Clinic and/or other recognized sources.
- Excellent verbal and written communication skills.
- Ability to mentor and instruct through audits.
- Strong organizational skills and attention to detail.
- Ability to work in a team environment and independently as needed.
- Demonstrate flexibility and adaptability.
- Superior clinical auditing and monitoring skills.
- Excellent decision-making skills and sound judgment.
- Strong technical knowledge and ability to learn new systems quickly.
- Ability to complete tasks efficiently and resolve problems within set timelines.
- Must be able to work under deadlines.
- Must be able to utilize independent decision-making skills in a wide variety of situations.
- Requires a high degree of accuracy in the performance of varied responsibilities.
- Personal computer skills required. Experience with: Excel, PowerPoint, Outlook, and Word.
- Strong interpersonal skills required.
What we offer:
- EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants
- You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills—key aspects for personal and professional growth
- We provide guidance/coaching to every employee through our mentoring program wherein every junior-level employee is assigned a senior-level professional as an advisor
- The sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond
Salary for this role is $85k - $92k
For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits
About Company
EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.
Company
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.
EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.