• Conduct coding audits of outpatient facility services, including ancillary procedures, PET scans, and simple visit encounters, to ensure coding accuracy and regulatory compliance. • Perform comprehensive audits and reviews of professional Evaluation and Management (E/M) documentation and coding to validate code assignment and reimbursement accuracy. • Provide ongoing feedback, education, and coaching to coding staff to improve coding quality, consistency, and adherence to coding guidelines. • Review and analyze clinical documentation and assigned codes from a variety of medical records to ensure accurate ICD-10-CM, CPT, and other applicable code assignment in accordance with current coding standards, regulatory requirements, and client-specific policies and guidelines.

• Independently audit clinical documentation to ensure consistent with billed services in a production environment • Apply clinical and industry guidelines, payer P&P, and use of in-depth knowledge that supports medically necessity of services rendered • Develop relationships with medical providers and health plans to confirm adherence to P&P, guidelines, and continuum of care. • Continually keep abreast of technology changes, regulatory issues, and medical practice through ongoing training and self-directed research and share with others, accordingly • Share ideas that offer process improvements and share with team for education.

Role Description Under the direction of the Sr. Manager of PCN Coding Integrity, the Coding Quality Educator will assist with the day-to-day operations of the PCN Coding Integrity Team and regional coding teams. This position will assist with: - New employee training and ongoing department education - Identification, development, and delivery of new and ongoing provider education and training related to coding and clinical documentation - Conducting independent and collaborative provider coding reviews according to the coding integrity work plan - Developing appropriate documentation to support coding review work performed Qualifications - Bachelor’s Degree in Management, Health Information Technology, or related field or an equivalent combination of education and experience - Upon hire: National Certification from American Academy of Professional Coders, or - Upon hire: National Certification from American Health Information Management Association - 4 years professional fee inpatient, surgical, outpatient coding, E/M, auditing and related work; 5 years preferred - 4 years experience conducting medical coding provider audits and quality performance measures; preparing audit reports with recommendations; and providing provider education and feedback to facilitate improvement in documentation and coding; 5 years preferred - Strong experience in Excel (e.g., pivot tables), database, e-mail, and Internet applications on a PC in a Windows environment Requirements - Associate's Degree in a Healthcare related field (preferred) - 5 years experience in coding for multispecialty practice (preferred) - 2 years experience in professional fee billing methodologies (preferred) - Experience with IDX, Allscripts, Advanced Web, Meditech (preferred) - Experience with project management (preferred) Benefits - Comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching - Health care benefits (medical, dental, vision) - Life insurance and disability insurance - Time off benefits (paid parental leave, vacations, holidays, health issues) - Voluntary benefits and well-being resources

Title: Master Premium Insurance Auditor - Remote Location: United States Job Description: - Job Identification16032 - Job RoleTotal Quality Management -Premium Audit - Experience (In Years)3-6 - Job LocationRemote Job Description About the EXL Insurance Premium Audit Group:   A leader in the field, EXL can complete all levels of premium audits on all auditable exposure types. We train our 450+ highly skilled professionals worldwide utilizing our industry-leading training platform and curriculum. This expertise is combined with a technology-enabled proprietary platform, with predictive modeling capabilities. Using a Premium Audit selection model, the team can predict the likelihood of policy misclassification, automatically assign audit methods to save carriers time and money, and use machine learning to continuously improve correlation and prediction accuracy.   To learn more about the EXL Insurance Premium Audit Group visit us at  www.exlservice.com/industries/insurance/premium-audit    Why work for the EXL Insurance Premium Audit Team? - 17 days paid vacation, plus 8 paid holidays - Additional 10 paid sick days - Superb training program - Work from home - Competitive total compensation package and benefits with 401k - Career advancement opportunities - Discounted health club benefits in many areas around the U.S. - Paid Parental Leave - Laptop and other necessary office equipment provided Compensation: - Pay Type: Hourly plus production bonus incentives, in accordance with EXL’s policies - Total compensation for this position, which is a combination of an hourly base rate plus production bonus incentives, is targeted between $50K–$70K in total earnings within the first year.: - Hourly base rate is dependent upon job specific experience and location. - There is no cap on production bonus incentives The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process. ***Applicants must have at least 2 years of experience in a premium auditor role*** Responsibilities The Role and Responsibilities: Working from your home office, this role requires scheduling appointments with the insured to be audited and obtain necessary documentation for our insurance company client audits all while adhering to customer requirements and quality standards. Territory: Remote Qualifications Qualifications: - Must have at least 2 yrs experience - Ability to work independently from home. - Experience with the MS Office Suite (excel, word, outlook, etc.) - Must be self-motivated, self-disciplined and exhibit a willingness to learn. - Excellent time management - Excellent verbal and written communication skills - Working knowledge of insurance and / or basic accounting principles is a plus.} - High School Diploma or GED required Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL salary range for this position. Actual salaries will vary depending on factors including but not limited to location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, a Paid Time Off policy, and many region-specific benefits.       Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.  EEO/Minorities/Females/Vets/Disabilities   Application & Interview Impersonation Warning– Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime.  We have implemented measures to deter and to uncover such unlawful conduct.  If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s). EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.