Job title: CVA Quality Analyst
Company: EXL Service
Job description: Company Overview and CultureEXL (NASDAQ: EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth. Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect. Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents. For information, visit .For the past 20 years, EXL has worked as a strategic partner and won awards in its approach to helping its clients solve business challenges such as digital transformation, improving customer experience, streamlining business operations, taking products to market faster, improving corporate finance, building models to become compliant more quickly with new regulations, turning volumes of data into business opportunities, creating new channels for growth and better adapting to change. The business operates within four business units: Insurance, Health, Analytics, and Emerging businesses.EXL Health is seeking an experienced Clinical DRG Quality Analyst. This is a remote office opportunity.The Quality Analyst IV oversees work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met. The analyst undertakes a quality review of random and targeted clinical DRG audits. The analyst applies expert clinical knowledge in the quality auditing of inpatient medical records to confirm the appropriate validation of the provider’s billed DRG code.
- Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding
- Responsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findings
- Mentor Clinical DRG auditors
- Utilize extensive clinical and industry knowledge to identify audit trends and identify referrals for DRG coding review
- Provide root cause analysis on errors
- Utilize industry and EXL proprietary tools in the DRG assignment process
- Write professional communications documenting audit findings and supporting rationales.
- 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
Qualifications
- Registered Nurse, Associate’s or Bachelor’s degree
- 5+ years of acute care nursing experience with preference given to candidates with prior clinical or coding validation audit experience.
- Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
- Prefer candidate with prior readmission (PPR) auditing experience.
- Preference given to candidates with CCS, RHIA, or RHIT coding credentials.
Knowledge and Skills:
- Superior auditing and monitoring skills
- Ability to mentor
- Extensive knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments.
- Experience with DRG encoder tools (3M, 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 DRG Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration
EEO/Minorities/Females/Vets/DisabilitiesTo view our total rewards offered click here —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.
Expected salary: $85000 per year
Location: New York City, NY
Job date: Fri, 27 Sep 2024 04:58:42 GMT
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