Outpatient Quality Analyst

EXL Health is seeking an experienced Outpatient Quality Analyst IV - QC Coder.  

This is a remote office opportunity. 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.

Responsibilities:

• Responsible for reviewing the accuracy and consistency of coding auditors to ensure audits are appropriately marked for findings and no findings.
• Provide root cause analysis on errors
• Mentor outpatient coders and provide feedback when required
• Perform quality reviews for initial audits and appeals
• Identify potential opportunities outside of the concept for additional recoveries.
• Recommend process changes to improve quality and performance
• Communicate with peers and management
• 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:

• 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)

Knowledge and Skills: 

• 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 based 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.

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