Be an early applicantLess than 25 applicants

Company

EXL · 13 hours ago

Outpatient Quality Analyst

SLC Metro Area

Full-time

Remote

Mid, Senior Level

$75K/yr - $85K/yr

5+ years exp

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Responsibilities

Responsible for reviewing the accuracy and consistency of coding auditors to ensure audits are appropriately marked for findings and no findings.

Provide root cause analysis on errors

Mentor outpatient coders and provide feedback when required

Perform quality reviews for initial audits and appeals

Identify potential opportunities outside of the concept for additional recoveries.

Recommend process changes to improve quality and performance

Communicate with peers and management

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

Qualification

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CCS certificationCPC certificationICD-10 CodingHCPCS/CPT codingMedicare OPPSAmbulatory Payment ClassificationMedicare LCD expertiseMedicare NCD expertiseModifier applicationClinical auditing skillsMicrosoft ExcelMicrosoft PowerPointMicrosoft OutlookMicrosoft Word

Required

CCS or CPC certified

Minimum 5 years coding experience: Professional or hospital coding with thorough understanding of ICD-10 Coding; HCPCS/CPT coding systems; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC)

Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)

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.

Demonstrate 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.