Quality Analyst & Trainer for Home Health

EXL•United States,

37d•$60,100 - $98,700•Remote

About The Position

This is a remote office opportunity. We are looking for a Quality Analyst & Trainer who is a licensed RN with strong organizational skills and a proactive, self-motivated attitude. The Quality Analyst & Trainer 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.

Requirements

Registered Nurse with a license in good standing in the state that you reside
7 years home health experience
Previous auditing experience
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

Nice To Haves

OASIS certification and/or coding certification preferred but not mandatory

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