Behavioral Health Quality Analyst

EXL•United States,

2d•$60,100 - $98,700•Remote

About The Position

The BH Quality Analyst IV oversees work performed by the BH 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 BH coding auditor determines if a discrepancy exists in the coding and documents the findings. The BH quality analyst undertakes a quality review of random and targeted coding audits to check the accuracy and completeness of audits performed.

Requirements

Minimum of five years of experience with Behavioral Health services, including mental health and substance use disorder treatment.
Strong knowledge of Behavioral Health coding, billing, clinical documentation, payer requirements, and applicable regulatory guidance.
Prior experience conducting retrospective Behavioral Health audits to identify overpayments preferred.
Experience performing quality reviews, secondary reviews, peer reviews, or audit validation for coding or clinical audit teams preferred.
Experience identifying quality trends, conducting root cause analyses, and recommending corrective actions to improve audit accuracy and consistency.
Experience mentoring auditors and providing feedback based on quality review results preferred.
Ability to review Behavioral Health medical records and determine whether audit findings are accurate, complete, and appropriately supported.
Knowledge of Behavioral Health coding, billing, modifier application, documentation requirements, payer policies, and applicable Medicare and NCCI guidelines.
Ability to write clear, professional audit notes supported by recognized resources, including Official Coding Guidelines, the ICD-10 Coding Handbook, Coding Clinic, payer policies, and other applicable references.
Excellent verbal and written communication skills.
Ability to mentor auditors and provide instruction through quality reviews and audit feedback.
Strong organizational skills, interpersonal skills, and attention to detail.
Ability to work effectively both independently and in a team environment.
Demonstrated flexibility and adaptability.
Advanced Behavioral Health auditing and quality monitoring skills.
Excellent decision-making skills, sound judgment, and the ability to make independent decisions in a variety of situations.
Strong technical aptitude and the ability to learn new systems quickly.
Ability to complete tasks efficiently, resolve problems within established timelines, and work effectively under deadlines.
High degree of accuracy in performing varied responsibilities.
Proficiency with Microsoft Excel, PowerPoint, Outlook, and Word.

Nice To Haves

One or more of the following credentials preferred: CCS, RHIA, RHIT, CPC, Registered Nurse, or MSW. Preference will be given to candidates with multiple credentials.

Responsibilities

Review the accuracy and consistency of work performed by Behavioral Health auditors to ensure audits are appropriately classified as findings or no-findings.
Perform random and targeted quality reviews of Behavioral Health audits to ensure findings and no-findings are accurate, complete, and supported by medical record documentation and applicable guidance.
Conduct root cause analyses of errors, quality trends, and missed opportunities.
Mentor Behavioral Health auditors and provide timely, constructive feedback based on quality review results.
Perform quality reviews of initial audits, appeals, and other assigned audit work.
Identify potential recovery opportunities outside the assigned audit concept and escalate them as appropriate.
Recommend process improvements that enhance quality, consistency, documentation standards, and performance.
Communicate quality results, trends, concerns, and recommendations clearly to peers and management.
Perform other duties as assigned.
Perform all job functions and responsibilities in accordance with company compliance, information security, and regulatory policies, procedures, and programs.