• In this fully remote position as an HCD Auditor you will apply your expert knowledge of billing HCD claims to perform extensive audit reviews. • You will utilize HCPCS codes, medical record review, industry and EXL proprietary tools in the audit process. • Write professional communications documenting audit findings and supporting rationales. • You will also apply your extensive industry knowledge to identify audit trends and opportunities.

• Conduct Home Health reviews to verify the accuracy of the billed services based on CMS guidelines. • Apply CMS guidelines during medical record review to ensure services provided are supported. In addition, utilize industry and proprietary tools to maximize overpayment identifications. • Document audit results in a clear, concise, and effective manner using CMS Home Health, Oasis and ICD-10 CM Guidelines. • Utilize proprietary workflow systems and encoder tools (e.g., Decision Health, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly. • Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals. • Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements. • Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

• Audit medical records to identify missed charges, incorrect coding, and other inconsistencies that result in missed billing opportunities • Perform Root Cause Analyses and report findings that identify common issues, including over-coding, under-coding and missed billing opportunities • Retrieves any missing patient information and documentation required for billing • Complete coding of unbilled records identified through audits • Prepare reports, executive summaries, and examples of audit findings for presentation and educational purposes • Assist with Clinical Documentation recommendation, coding guidance research, and the development of coding educational documents • Conduct ad-hoc audits as needed to provide root cause analysis and recommendations for resolution • Pre-payment audit: review billing vs documentation, send documentation to the payer, complete necessary charge corrections, and/or identify CDI (Clinical Documentation Improvement) opportunities • Provide resolution of missing documentation tasks • Retrieve or request necessary documents, code for billing, and data entry • Provide coding support to cross-functional team inquiries and special projects

• Independently lead, plan, schedule, perform, and report a range of technology audits • Perform and deliver high quality audits / audit reports within specified timelines / budgets • Travel internationally for audits, as required • Act as point of consultancy for Operations and Quality • Review audit reports, responses and other program deliverable