Quality Analyst Home Health, Lead Assistant Manager

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

• Responsible for reviewing the accuracy and consistency of clinical auditors to ensure audits are appropriately marked for findings and no findings
• Assist in mentoring clinical auditors
• Recommend process changes to improve quality and performance
• Provide root cause analysis on errors
• Provide updates to training and user manuals
• Communicate with peers and management
• Performance Management: achieves productivity and quality goals
• Teamwork: responds timely to emails and meeting requests; actively participates in discussions, providing suggestions of improvement or volunteers when needed
• Continuous Improvement/Education actively participates with team to ensure alignment and sustained results; attends training (assigned or self-initiated) to improve performance or capitalize on new overpayment trends; keeps up with CMS, OIG, and other publications related to our business
• Will perform other duties as assigned
• Registered Nurse with a license in good standing in the state that you reside
• 7 plus years of home health experience
• Previous auditing experience
• OASIS certification and/or coding certification preferred

Knowledge and Skills

• Experience, or equivalent, coding or auditing of Home Health OASIS and non-OASIS claims
• Ability to review SOC/ROC/Recert assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy
• Ability to ensure appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition
• Knowledge of CMS/Chapter 7 Home Health Coverage Guidelines, National Coverage Guidelines, and HH PPS Reimbursement
• Ability to pinpoint, extract, and use record information to cite issues related to the overpayment
• Assists the program/team in returning client overpayments and achieving internal revenue goals
• Superior clinical auditing and monitoring skills
• Excellent decision-making skills and sound judgement
• Thorough understanding of medical terminology and human physiology
• Strong technical knowledge and ability to learn new systems quickly
• Excellent verbal and written communication skills
• Ability to mentor and instruct through audits
• Strong organizational skills and high attention to detail
• Demonstrated flexibility and adaptability
• Ability to work in a team environment and independently as needed
• Working knowledge of Microsoft Excel

The posted base salary range is the hiring base salary range for this role. 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.