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EXL logo
EXL

We make sense of data to drive your business forward. #MakeSenseofData #DriveYourBusinessForward #PartnerYourWay

Quality Analyst

AnalystAnalystFull TimeRemoteSeniorTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

62 days ago

Salary

$85K - $92K / year

Seniority

Senior

Professional Certificate5 yrs expEnglish

Job Description

Quality Analyst

EXL

• 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. • Determines if a discrepancy exists in the coding and documents the findings. • Undertakes a quality review of random and targeted coding audits to check the accuracy and completeness of audits performed. • 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.

Job Requirements

  • 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)
  • Must have the ability to code a wide variety of complex outpatient services such as interventional radiology, ambulatory surgery, emergency room and observation.
  • 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.

Benefits

  • 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.
  • 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

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