Quality Analyst

Role Overview

• The Quality Analyst IV 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.
• The coding auditor determines if a discrepancy exists in the coding and documents the findings.
• The quality analyst undertakes a quality review of random and targeted coding audits to check the accuracy and completeness of audits performed.

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. Reviews medical records to determine if facility coding is accurate.
• 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.