Quality Analyst Outpatient

Quality Analyst Outpatient

EXL Health is seeking a remote Quality Analyst IV to oversee the Outpatient audit program. This role ensures the accuracy of medical coding billed against documentation, identifying discrepancies and performing quality reviews of audits.

Responsibilities

• Review coding auditors' accuracy and consistency for appropriate findings.
• Conduct root cause analysis on errors.
• Mentor outpatient coders and provide feedback.
• Perform quality reviews for initial audits and appeals.
• Identify opportunities for additional recoveries.
• Recommend process improvements for quality and performance.
• Communicate with peers and management.
• Perform other duties as assigned.
• Adhere to all company Compliance, Information Security, and Regulatory policies.

Qualifications

• CCS or CPC certification required.
• Minimum 5 years of coding experience (professional or hospital).
• Thorough understanding of ICD-10 Coding, HCPCS/CPT coding systems, Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC).
• Expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD).

Knowledge and Skills

• Ability to code complex outpatient services (interventional radiology, ambulatory surgery, ER, observation).
• Proficiency in modifier application following Medicare and NCCI guidelines.
• Ability to write professional notes citing Official Coding Guidelines, ICD-10 Coding Handbook, Coding Clinic, etc.
• Excellent verbal and written communication skills.
• Mentoring and instruction abilities through audits.
• Strong organizational skills and attention to detail.
• Ability to work both independently and in a team environment.
• 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 timelines.
• Ability to work under deadlines and utilize independent decision-making skills.
• Requires a high degree of accuracy.
• Proficiency in personal computer skills (Excel, PowerPoint, Outlook, Word).
• Strong interpersonal skills required.

What we offer

EXL Health offers an exciting, fast-paced, and innovative environment with sharp, entrepreneurial professionals. You will have the opportunity to work closely with highly experienced Healthcare consultants, learn various aspects of client businesses, and develop effective teamwork and time-management skills. Our mentoring program pairs junior-level employees with senior-level professionals for guidance and coaching. The opportunities for growth and development at EXL Health are significant.

Key skills/competency

• Quality Assurance
• Medical Coding
• ICD-10
• CPT
• Outpatient Auditing
• Medicare OPPS
• Clinical Auditing
• Root Cause Analysis
• Coder Mentoring
• Compliance