Outpatient Quality Analyst IV

EXL • Full-time • Remote (United States) • $75k - $85k / year • 3d ago

Company Overview and Culture

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.

About EXL Health

We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.

EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.

We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.

Remote Certified Outpatient Auditor

Are you a skilled Certified Outpatient Auditor with a passion for ensuring fair reimbursement and maintaining high standards of healthcare coding integrity? If so, we want you to join our dynamic, remote team at EXL Health!

As a Remote Certified Outpatient Auditor, you’ll bring your expert knowledge of outpatient coding, CPT coding guidelines, and reimbursement methodologies to audit outpatient and professional fee medical records. Your work will directly contribute to validating the provider’s billed CPT codes and ensuring claims are accurate, fair, and compliant.

This exciting opportunity allows you to work from home, be a key player in driving excellence in the healthcare coding industry!

Key Responsibilities:

Conduct CPT and Ambulatory Payment Classification (APC) reviews to verify the accuracy of CPT coding and APC reimbursement for outpatient and professional claims.
Apply Medicare, NCCI, and other coding guidelines to a wide range of claims and use both industry tools and EXL proprietary tools to identify potential overpayments.
Document audit findings and rationales clearly and professionally, utilizing AHA Coding Clinic and CPT coding rules.
Leverage proprietary workflow systems and encoder tools to make accurate audit determinations and effectively move claims through the workflow.
Meet or exceed EXL's productivity and quality goals, ensuring timely and accurate audit results.
Stay up to date on coding guideline changes and reimbursement trends and apply this knowledge to improve audit outcomes.
Maintain compliance with EXL’s policies and procedures, including HIPAA and other state and federal regulations.

Qualifications:

Required:

One or more of the following credentials:
Certified Coding Specialist (CCS)
Registered Health Information Administrator (RHIA)
Registered Health Information Technician (RHIT)
Certified Professional Coder (CPC)
Preference given to candidates with multiple credentials
3+ years of professional and hospital outpatient coding experience, including expertise in AHA and CPT Coding Guidelines and APC reimbursement methodologies.
Familiarity with healthcare payer contract language.

Preferred:

Experience with APC retrospective overpayment identification in specialties like surgical, radiology, etc.
Superior knowledge of CPT coding, Official Coding Guidelines, Coding Clinic Guidance, and National Correct Coding Initiative (NCCI) guidelines.
Experience using encoder tools.
Ability to work independently in a remote environment while delivering exceptional results during EXL’s core business hours.
Excellent time management skills and ability to prioritize work.
Strong analytical, written, and verbal communication skills.
Proficiency in Excel, Word, and OneNote with a general understanding of computer systems.

What We Offer:

At EXL Health, we provide an exciting and innovative environment where healthcare professionals come together to influence business decisions and contribute to improving the healthcare industry. Here’s what you can expect:

Collaborative environment: Work alongside world-class healthcare consultants and be a part of a supportive team that values your input.
Career growth: Learn new skills and gain exposure to different aspects of business operations while working in a fast-paced and engaging environment.
Mentoring program: Receive guidance from experienced mentors who will help you develop professionally and provide career insights.
Professional development: We encourage continuous growth and provide opportunities for you to excel within EXL Health and beyond.
Work-life balance: Enjoy the flexibility of a remote work-from-home position, with occasional travel to expand your professional network.

At EXL Health, the sky's the limit for your professional growth. Join us and be a part of a company that values teamwork, excellence, collaboration, and support.

Ready to join an exciting team and make an impact in the healthcare industry? Apply now and start your journey with EXL Health!

EEO/Minorities/Females/Vets/Disabilities

To view our total rewards offered click here —> https://www.exlservice.com/us-careers-and-benefits

Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.

Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.

Application & Interview Impersonation Warning – Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the “Company”) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).

EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate’s full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.