Inpatient Rehabilitation Facility Quality Analyst – Healthcare

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Job Description

EXL healthcare quality analyst validating inpatient rehabilitation audits, coding, and reimbursement documentation. Identifying quality trends and coaching auditors to improve accuracy and compliance.

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
Validate audit findings, no-findings, documentation support, coding logic, reimbursement impact, and audit rationale
Follow approved sampling methodology and quality review procedures
Apply quality scoring criteria to evaluate audit accuracy, documentation quality, client requirements, and EXL quality standards
Confirm audit determinations are supported by IRF-PAI, UB-04/final bill, medical records, therapy and physician documentation, nursing documentation, orders, MAR, pre-admission screening, plan of care, interdisciplinary documentation, CMS guidance, payer requirements, and internal procedures
Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, onset date, comorbidities, complications, treatment, and reimbursement support
Review audit documentation for clarity, completeness, grammar, evidence-based support, and communication quality
Identify documentation, coding, and reimbursement discrepancies affecting IRF payment
Provide professional feedback and coaching to IRF Auditors
Identify audit trends, recurring errors, documentation gaps, inconsistent audit logic, and process or training needs
Perform root cause analysis and recommend corrective actions
Support calibration discussions, quality monitoring, score reviews, procedure updates, and training
Write communications documenting review outcomes, findings, rationale, trends, coaching recommendations, and next steps
Maintain quality review results and reporting for monitoring, trend analysis, leadership review, coaching, and improvement
Communicate quality results, risks, trends, and recommendations to peers and management
Stay current with IRF reimbursement updates, CMS guidance, IRF-PAI manuals, ICD-10-CM/PCS updates, payer policies, and internal procedures
Perform duties in accordance with compliance, information security, HIPAA, regulatory policies, procedures, and programs

Requirements:

Minimum High School Diploma required
5+ years of inpatient facility coding, auditing, payment integrity, reimbursement review, quality review, audit validation, or related healthcare experience preferred
Strong IRF audit, IRF coding, IRF reimbursement, IRF-PAI, or rehabilitation facility documentation review experience preferred
Strong understanding of ICD-10-CM/PCS, inpatient facility claim review, medical record abstraction, documentation validation, payer reimbursement methodologies, audit scoring expectations, and the relationship between documentation, coded data, IRF-PAI elements, and reimbursement outcomes
Experience identifying quality errors, missed opportunities, documentation gaps, inconsistent audit application, and trends in complex inpatient or IRF audit work
Experience reviewing lengthy medical records and tying documentation to reimbursement impact, treatment during the IRF stay, payer/client requirements, and audit findings
Ability to provide constructive feedback and coaching to auditors
Ability to evaluate auditor work objectively and distinguish IRF-PAI documentation requirements from traditional acute-care DRG coding logic
Strong analytical, problem-solving, root cause analysis, and critical-thinking skills
Excellent attention to detail and documentation accuracy
Excellent written and verbal communication skills
Ability to work independently in a remote environment while maintaining quality, productivity, confidentiality, and timely completion
Proficient in Excel, Word, Outlook, OneNote, and general computer applications
Commitment to teamwork, calibration, continuous learning, consistent quality application, process improvement, and accurate audit outcomes
Required knowledge of 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, and HIPAA Compliance

Benefits:

100% remote work from home
Up to 10% annual travel for team meetings and limited client onsite engagements
Benefits information provided through EXL’s US careers and benefits program

Inpatient Rehabilitation Facility Quality Analyst – Healthcare

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