Home Health Quality Analyst IV

EXL is seeking a candidate for the remote position of Quality Analyst IV Home Health.

This is a remote office opportunity. We are looking for a Quality Analyst who is a licensed RN with strong organizational skills and a proactive, self-motivated attitude.  The Quality Analyst IV oversees work performed by the home health clinical audit program to ensure that EXL’s standard of accuracy is met. The analyst undertakes quality review of random and targeted clinical coding audits, involving and consulting with clinical auditors, clinicians, and managers to enhance the accuracy and completeness of audits performed. Additionally, the analyst develops audit feedback sessions to all staff from routine internal audit, identifying general training trends and requirements. The ideal candidate should possess both home health expertise and prior experience in auditing.

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

Qualifications:

• Registered Nurse with a license in good standing in the state that you reside
• 7 years home health experience
• Previous auditing experience
• OASIS certification and/or coding certification preferred but not mandatory

Knowledge and Skills:

• 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