Quality Analyst – Outpatient, Healthcare
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Job Description
EXL Health quality analyst auditing outpatient medical coding for accuracy and compliance. Coaching coders and improving healthcare audit processes.
Responsibilities:
- Review coding audits to ensure findings are accurate, consistent, and compliant
- Provide coaching and support to coders to enhance accuracy and confidence
- Deliver feedback from audit reviews and identify training needs or process gaps
- Contribute to improving audit methods, processes, and documentation
- Collaborate closely with peers and leadership to drive quality improvements
- Provide root cause analyses for coding discrepancies
- Support compliance with company and regulatory standards
- Take on additional tasks and challenges as needed in a dynamic environment
Requirements:
- High School Diploma (required)
- CCS or CPC certification (required)
- At least 5 years of coding experience across both professional and hospital settings
- Deep knowledge of ICD-10, HCPCS/CPT, Medicare OPPS, and APCs
- Skilled in using encoder tools (Optum, TrueCode, 3M, Webstrat)
- Familiar with Medicare LCD and NCD guidelines
- Ability to code complex outpatient services, including interventional radiology, ambulatory surgery, ER, and observation
- Expertise in applying modifiers and following Medicare/NCCI rules
- Strong documentation skills with the ability to reference official coding guidelines
- Excellent communication, organization, and problem-solving abilities
- Comfortable working independently or as part of a team
- Tech-savvy with Microsoft Office (Excel, PowerPoint, Outlook, Word)
- A brief coding/auditing assessment may be included as part of the interview process
Benefits:
- Remote work flexibility
- Opportunities for growth and mentorship through a structured coaching program
- Collaborative culture where ideas and insights are valued
- Opportunities for advancement
- Fast-paced, innovative environment
- Meaningful work impacting healthcare delivery nationwide
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