DRG Quality Analyst

EXL Health is seeking an experienced DRG Quality Analyst.

This is a remote office opportunity. The Quality Analyst IV oversees work performed by the DRG audit program to ensure that EXL’s standard of accuracy is met. The analyst undertakes a quality review of random and targeted DRG audits. 

Responsibilities

• Responsible for reviewing the accuracy and consistency of DRG coding auditors to ensure audits are appropriately marked for findings and no findings.
• Recommend process changes to improve quality and performance
• Communicate with peers and management
• Provide root cause analysis on errors
• Identify potential opportunities outside of the concept for additional recoveries.
• Perform other duties as assigned
• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs

Qualifications

• Minimum 5 years relevant DRG and APR DRG coding/auditing experience
• Expert knowledge of ICD-10 coding/reimbursement methodology
• One of the following certifications: RHIT, RHIA, CCS, or CPC
• Active/current certification
• Preferred, associate or bachelor’s degree in nursing

Knowledge and Skills:

• Superior auditing and monitoring skills
• Excellent decision-making skills and sound judgment
• Thorough understanding of medical terminology and human physiology
• Strong technical knowledge and ability to learn new systems quickly
• Excellent oral/presentation and written communication skills
• Ability to complete tasks efficiently and resolve problems within set timelines
• Excellent client and customer service skills
• Ability to mentor and instruct
• Strong organizational skills and attention to detail
• Ability to work in a team environment and independently as needed
• Demonstrated flexibility and adaptability
• 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. Must be self-motivated to complete work in a timely manner to meet deadlines
• Strong interpersonal skills required

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 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