EXL · 1 day ago

Auditor III - Home Health

Syracuse-Auburn Area

Full-time

Remote

Mid Level

$75K/yr - $85K/yr

3+ years exp

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Responsibilities

Conduct Home Health reviews to verify the accuracy of the billed services based on CMS guidelines.

Apply CMS guidelines during medical record review to ensure services provided are supported. In addition, utilize industry and proprietary tools to maximize overpayment identifications.

Document audit results in a clear, concise, and effective manner using CMS Home Health, Oasis and ICD-10 CM Guidelines.

Utilize proprietary workflow systems and encoder tools (e.g., Decision Health, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.

Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.

Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.

Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.

Qualification

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

LPNRegistered NurseOASIS CertificationCoding CertificationAcute Care NursingPDGM KnowledgePPS KnowledgeEncoder ToolsICD-10Decision HealthWebstratExcelWordOneNote

Required

LPN, Registered Nurse with Associate's or Bachelor's degree preferred

3+ years of acute care nursing experience with preference given to candidates with OASIS or Coding Certification.

Prior Home Health auditing experience.

Extensive knowledge of PDGM and PPS payment methodologies.

Experience with encoder tools (Decision Health, ICD-10, Webstrat).

Works independently in a remote environment and delivers exceptional results during EXL core business hours.

Possesses excellent time management and work prioritization skills.

Takes ownership of problem solving.

Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.

Proficient in Excel, Word, and OneNote with general computer literacy.

Passionate about Home Health Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.