[Remote] Quality Analyst Home Health, Lead Assistant Manager
Note: The job is a remote job and is open to candidates in USA. EXL is a leading data analytics and digital operations company. They are seeking a Quality Analyst Home Health, Lead Assistant Manager to oversee clinical auditing processes, mentor auditors, and implement quality improvements.
Responsibilities
- 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
Skills
- Registered Nurse with a license in good standing in the state that you reside
- 7 plus years of home health experience
- Previous auditing experience
- 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
- OASIS certification and/or coding certification preferred
Company Overview
Company H1B Sponsorship