[Hiring] IRF Quality Analyst IV @EXL

Role Description

The IRF Quality Analyst performs random, targeted, and follow-up quality reviews to confirm that audit determinations are supported by various documentation. This position requires strong IRF audit knowledge, sound judgment, attention to detail, and the ability to determine whether auditor conclusions are fully supported by the record, aligned with client and program requirements, and clearly explained.

• Identify quality trends and provide feedback and coaching support to auditors.
• Participate in calibration and recommend process improvements that strengthen audit accuracy, documentation quality, consistency, and overall program performance.

Responsibilities

• Apply IRF audit, coding, reimbursement, and documentation expertise to evaluate the accuracy and consistency of completed IRF Auditor work.
• Perform random, targeted, follow-up, and focused quality reviews of completed IRF audits to validate findings, no-findings, documentation support, coding logic, reimbursement impact, and audit rationale.
• Follow approved sampling methodology and quality review procedures to ensure reviews are completed consistently, objectively, and in alignment with program expectations.
• Apply established quality scoring criteria to evaluate audit accuracy, documentation quality, adherence to client requirements, and alignment with EXL quality standards.
• Confirm that IRF audit determinations are supported by various documentation including IRF-PAI, UB-04/final bill, and interdisciplinary team documentation.
• Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, and treatment received during the IRF stay.
• Review audit documentation for clarity, completeness, grammar, evidence-based support, and alignment with EXL communication and quality expectations.
• Identify documentation, coding, and reimbursement discrepancies that may impact IRF payment.
• Provide clear, professional feedback and coaching support to IRF Auditors based on quality review outcomes.
• Use IRF, coding, reimbursement, and payment integrity knowledge to identify audit trends and potential process or training needs.
• Perform root cause analysis on quality errors and recommend corrective actions.
• Support calibration discussions, quality monitoring, and training opportunities.
• Write professional communications documenting quality review outcomes and next steps.
• Maintain quality review results and reporting to support performance monitoring and ongoing quality improvement.
• Communicate quality results, barriers, risks, trends, and improvement recommendations to peers and management.
• Stay current with IRF reimbursement updates and internal program procedures.
• Conduct all job functions in accordance with company Compliance, Information Security, HIPAA, and regulatory policies.

Qualifications

• Minimum High School Diploma required; associate’s or bachelor’s degree in Health Information Management, healthcare administration, nursing, rehabilitation services, or a related healthcare field preferred.
• CCS, RHIA, RHIT, CIC, CPC, or comparable coding credential preferred; multiple coding credentials strongly preferred.
• Strong preference for candidates with demonstrated IRF audit, IRF coding, IRF reimbursement, or rehabilitation facility documentation review experience.
• Clinical licensure or rehabilitation facility experience is a plus; active RN licensure is not required unless specified by client scope.
• 5+ years of inpatient facility coding, auditing, payment integrity, reimbursement review, or related healthcare experience preferred.
• Prior experience reviewing IRF audits or IRF-PAI documentation is highly desirable.
• Strong understanding of ICD-10-CM/PCS and audit scoring expectations.
• Ability to provide constructive feedback to auditors in a professional manner.

Required Skills

• IRF Quality Review
• Inpatient Rehabilitation Facility (IRF)
• IRF-PAI Validation
• IRF PPS / HIPPS Methodology
• ICD-10-CM/PCS
• Medical Record Review
• Audit Sampling
• Quality Scoring
• Documentation Validation
• Root Cause Analysis
• Quality Feedback
• Calibration
• Trend Identification
• Written Communication
• HIPAA Compliance