[Hiring] Quality Analyst & Trainer @EXL

Role Description

This is a remote office opportunity. We are looking for a Quality Analyst & Trainer who is a licensed RN with strong organizational skills and a proactive, self-motivated attitude. The Quality Analyst & Trainer oversees work performed by the home health clinical audit program to ensure that EXL’s standard of accuracy is met.

• Undertakes quality review of random and targeted clinical coding audits.
• Involves and consults with clinical auditors, clinicians, and managers to enhance the accuracy and completeness of audits performed.
• Develops audit feedback sessions to all staff from routine internal audit, identifying general training trends and requirements.
• Ideal candidate should possess both home health expertise and prior experience in auditing.

Salary Range: $60,100 – $98,700

Location: 100% Remote (U.S.-based)

Up to 10% annual travel (for team meetings and limited client onsite engagements.)

Responsibilities

• Responsible for reviewing the accuracy and consistency of clinical auditors to ensure audits are appropriately marked for findings and no findings.
• Assist in mentoring clinical auditors.
• Recommend process changes to improve quality and performance.
• Provide root cause analysis on errors.
• Provide updates to training and user manuals.
• Communicate with peers and management.
• Performance Management: achieves productivity and quality goals.
• Teamwork: responds timely to emails and meeting requests; actively participates in discussions, providing suggestions of improvement or volunteers when needed.
• Continuous Improvement/Education: actively participates with team to ensure alignment and sustained results; attends training (assigned or self-initiated) to improve performance or capitalize on new overpayment trends; keeps up with CMS, OIG, and other publications related to our business.
• Will perform other duties as assigned.

Qualifications

• Registered Nurse with a license in good standing in the state that you reside.
• 7 years home health experience.
• Previous auditing experience.
• OASIS certification and/or coding certification preferred but not mandatory.

Knowledge and Skills

• Experience, or equivalent, coding or auditing of Home Health OASIS and non-OASIS claims.
• Ability to review SOC/ROC/Recert assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy.
• Ability to ensure appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition.
• Knowledge of CMS/Chapter 7 Home Health Coverage Guidelines, National Coverage Guidelines, and HH PPS Reimbursement.
• Ability to pinpoint, extract, and use record information to cite issues related to the overpayment.
• Assists the program/team in returning client overpayments and achieving internal revenue goals.
• Superior clinical auditing and monitoring skills.
• Excellent decision-making skills and sound judgement.
• Thorough understanding of medical terminology and human physiology.
• Strong technical knowledge and ability to learn new systems quickly.
• Excellent verbal and written communication skills.
• Ability to mentor and instruct through audits.
• Strong organizational skills and high attention to detail.
• Demonstrated flexibility and adaptability.
• Ability to work in a team environment and independently as needed.
• Working knowledge of Microsoft Excel.

Benefits

• A fast-paced, innovative environment with a team of sharp, driven professionals.
• Remote work flexibility and a chance to impact healthcare delivery nationwide.
• Opportunities for growth and mentorship through our structured coaching program.
• A collaborative culture where your ideas and insights are valued.
• Real opportunities for advancement—your future here is what you make it!