EXL Health is seeking an experienced DRG Quality Analyst.

This is a remote office opportunity. To apply directly to this position, please visit https://us242.dayforcehcm.com/CandidatePortal/en-US/exl/Posting/View/65986

The Quality Analyst IV oversees work performed by the DRG audit program to ensure that EXL’s standard of accuracy is met. The analyst undertakes a quality review of random and targeted DRG audits.

Responsibilities

• Responsible for reviewing the accuracy and consistency of DRG coding auditors to ensure audits are appropriately marked for findings and no findings.
• Recommend process changes to improve quality and performance
• Communicate with peers and management
• Provide root cause analysis on errors
• Identify potential opportunities outside of the concept for additional recoveries.
• 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

• Minimum 5 years relevant DRG and APR DRG coding/auditing experience
• Expert knowledge of ICD-10 coding/reimbursement methodology
• One of the following certifications: RHIT, RHIA, CCS, or CPC
• Active/current certification
• Preferred, associate or bachelor’s degree in nursing

Knowledge and Skills:

• Superior auditing and monitoring skills
• Excellent decision-making skills and sound judgment
• Thorough understanding of medical terminology and human physiology
• Strong technical knowledge and ability to learn new systems quickly
• Excellent oral/presentation and written communication skills
• Ability to complete tasks efficiently and resolve problems within set timelines
• Excellent client and customer service skills
• Ability to mentor and instruct
• Strong organizational skills and attention to detail
• Ability to work in a team environment and independently as needed
• Demonstrated flexibility and adaptability
• 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. Must be self-motivated to complete work in a timely manner to meet deadlines
• Strong interpersonal skills required