Outpatient Expert - Manager

EXL Health Analytics is looking for an Outpatient/Ambulatory Payments Classifications (APC) SME. This is a remote, work from home opportunity.
 

The successful candidate will manage a team of expert auditors, responsible for reviewing Outpatient and APC selected cases for appropriate coding and reimbursement appropriate. The successful candidate will him/herself possess the coding skill set and sufficient experience to help train and guide a team of expert coders by demonstrating mastery of the coding guidelines, coding clinics, and support tools. The successful candidate will also possess strong working knowledge of CMS rules guidelines and is abreast of regulatory changes.

Responsibilities:

• The successful candidate will lead a team of coding auditors, reviewing selected outpatient claims for appropriate coding and reimbursement.
• Possess the coding skill set and experience to lead a team of experienced coders by demonstrating mastery of the coding guidelines, CPT classification systems, billing and reimbursement process and support tools.
• This candidate will possess a strong working knowledge of NCCI edits and will be abreast of regulatory changes.
• The Outpatient/APC Subject Matter Expert (SME) is expected to actively participate in the selections process initiatives, monitor the program performance, review results and fine tune the selections queries working with the selections analytics team. In addition, the outpatient SME will ensure audit staff is trained, aligned, and well able to achieve established goals and performance requirements.
• Responsible for setting up a tight quality assurance process, perform QC on the work performed by the team, provide feedback and coach the team in areas that need attention, take corrective action where necessary.
• On an ongoing basis the outpatient SME will be expected to perform random and focused quality assurance audits, ensuring staff receives monthly feedback and performance updates.
• Will ensure all facilities disputes are reviewed and effectively addressed.
• Provide daily support and direction of program activities.
• Participate in client calls and represent the program on subject matter expertise around outpatient coding, and provider calls to collaborate audit decisions and work towards maintaining and growing the audit program.
• Overall the outpatient SME will be responsible for the successful management of the audit program, client relationships and assists with new audit program implementation / development / enhancements for new / existing clients.

Qualifications:

• CCS-P- Certified Coding Specialist Physician, CPC – Certified Procedural Coder. Noteworthy CCS - Certified Coding Specialist.
• RHIT - Registered Health Information Technologist.
• 10 plus years’ experience with outpatient auditing/coding
• Expert knowledge of ICD-9, ICD-10, CPT and HCPCS coding guidelines.
• Experience with encoder tools (TrueCode, 3M, Webstrat, Pricers).
• Possess strong leadership and organizational skills, with 3-5 years of supervisory experience, the ability to develop work plans, action plans, and standard operating procedures. To include the ability to build a strong teamwork environment of inclusiveness and support.
• Excellent verbal / written communication skills, with the ability to lead training. Team calls, etc.
• Experience with need programs such as: Excel, PowerPoint, Outlook, and Word.

What we offer:

• 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. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants.
• 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 advisors.
• 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.