Behavioral Health Quality Analyst
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Job Description
Behavioral Health Quality Analyst reviewing coding audits for EXL, a data analytics and digital operations company. Identifying errors, mentoring auditors, and improving healthcare audit quality.
Responsibilities:
- Review the accuracy and consistency of Behavioral Health auditors’ work and classifications
- Perform random and targeted quality reviews of Behavioral Health audits
- Verify findings and no-findings against medical record documentation and applicable guidance
- Conduct root cause analyses of errors, quality trends, and missed opportunities
- Mentor Behavioral Health auditors and provide timely, constructive feedback
- Review initial audits, appeals, and other assigned audit work
- Identify and escalate potential recovery opportunities outside assigned audit concepts
- Recommend process improvements for quality, consistency, documentation standards, and performance
- Communicate quality results, trends, concerns, and recommendations to peers and management
- Perform duties in accordance with company compliance, information security, and regulatory policies
Requirements:
- Minimum of five years of experience with Behavioral Health services, including mental health and substance use disorder treatment
- One or more of the following credentials preferred: CCS, RHIA, RHIT, CPC, Registered Nurse, or MSW
- Strong knowledge of Behavioral Health coding, billing, clinical documentation, payer requirements, and applicable regulatory guidance
- Prior experience conducting retrospective Behavioral Health audits to identify overpayments preferred
- Experience performing quality reviews, secondary reviews, peer reviews, or audit validation for coding or clinical audit teams preferred
- Experience identifying quality trends, conducting root cause analyses, and recommending corrective actions
- Experience mentoring auditors and providing feedback based on quality review results preferred
- Ability to review Behavioral Health medical records and determine whether audit findings are accurate, complete, and appropriately supported
- Knowledge of Behavioral Health coding, billing, modifier application, documentation requirements, payer policies, Medicare, and NCCI guidelines
- Ability to write clear, professional audit notes using Official Coding Guidelines, the ICD-10 Coding Handbook, Coding Clinic, payer policies, and other applicable references
- Ability to mentor auditors and provide instruction through quality reviews and audit feedback
- Advanced Behavioral Health auditing and quality monitoring skills
- Strong technical aptitude and ability to learn new systems quickly
- Proficiency with Microsoft Excel, PowerPoint, Outlook, and Word
- Ability to work independently and in a team environment
- Ability to complete tasks efficiently and work effectively under deadlines
Benefits:
- Remote work flexibility
- Up to 10% annual travel for team meetings and limited client onsite engagements
- Opportunities for growth and mentorship through a structured coaching program
- Collaborative culture where ideas and insights are valued
- Real opportunities for advancement
- Fast-paced, innovative work environment
- Opportunity to impact healthcare delivery nationwide
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