Outpatient Quality Analyst IV - QC Coder
Employment Type : Full-Time
Outpatient Quality Analyst IV - QC CoderVirtual Req #49 Sunday, January 17, 2021
Overview
EXL (NASDAQ: EXLS) is a leading operations management and analytics company that designs and enables agile, customer-centric operating models to help clients improve their revenue growth and profitability. Our delivery model provides market-leading business outcomes using EXL’s proprietary Business EXLerator Framework™, cutting-edge analytics, digital transformation and domain expertise. At EXL, we look deeper to help companies improve global operations, enhance data-driven insights, increase customer satisfaction, and manage risk and compliance. EXL serves the insurance, healthcare, banking and financial services, utilities, travel, transportation and logistics industries. Headquartered in New York, New York, EXL has more than 32,000 professionals in locations throughout the United States, Europe, Asia (primarily India and Philippines), South America, Australia and South Africa. For more information, visit www.exlservice.com. EXL Health, is seeking an experienced Outpatient Quality Analyst IV - QC Coder.
This is a remote office opportunity. The Quality Analyst III 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 analyst undertakes a quality review of random and targeted coding audits to check 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.
Responsibilities:- Responsible for reviewing the accuracy and consistency of coding auditors to ensure audits are appropriately marked for findings and no findings.
- Assist in mentoring Coders
- Provide updates to training and user manuals
- Recommend process changes to improve quality and performance
- Communicate with peers and management
- Provide root cause analysis on errors
- Will 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:- High School Diploma
- CCS or CPC certified
- Minimum 5 years coding experience: Professional and hospital coding
- Must have thorough understanding of ICD-10 Coding; HCPCS/CPT coding systems; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC)
- Experience with Encoder tools (Optum, TrueCode, 3M, Webstrat)
- 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.
- Demonstrated 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 advisors.
- 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.
EEO/Minorities/Females/Vets/Disabilities
Other details
- Pay Type
Salary
- Travel Required
Yes
- Travel %
3