About this role
Role Overview
- Audit and review Behavioral Health claims to identify potential errors.
- Analyze data against payer policies, procedures, and regulatory requirements.
- Document findings clearly and professionally to support next steps.
- Recommend claim adjustments or recoveries when necessary.
- Collaborate with cross-functional teams to solve problems and drive improvements.
- Stay ahead of the curve on regulations, laws, and industry standards.
- Track and report audit findings, spotting trends and opportunities.
- Share your expert knowledge to guide teams on Behavioral Health payment integrity issues.
- Meet EXL’s productivity and quality goals while maintaining compliance with HIPAA and other regulations.
Requirements
- Education: Bachelor’s degree in healthcare administration, business, finance, or a related field.
- Experience: 3+ years in Behavioral Health services (mental health and substance use disorder treatment).
- Credentials (Preferred): CCS, RHIA, RHIT, CPC, RN, MSW – bonus points if you have multiple!
- Expertise: Strong understanding of Behavioral Health standards, payer policies, and regulations.
- Bonus: Experience in Behavioral Health retrospective overpayment auditing.
Benefits
- For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits