Quality Analyst – Outpatient, Healthcare
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Job Description
Outpatient Quality Analyst reviewing complex medical coding audits for EXL, a data analytics and digital operations company. Ensuring accuracy, compliance, trend detection, and coder quality.
Responsibilities:
- Review coding auditors’ work for accuracy and consistency
- Validate audit determinations, supporting documentation, and rationales against client and program expectations
- Review medical records to determine facility coding accuracy
- Assign root cause analysis categories and flag recurring trends to the Quality Manager
- Mentor coding auditors and provide feedback
- Perform quality reviews for initial audits and appeals
- Manage QA inventory and meet quality, productivity, and turnaround expectations
- Identify overpayment and underpayment findings and support audit reporting and trend analysis
- Participate in calibration sessions for consistent review decisions and coding guidance application
- Recommend process improvements
- Escalate recurring errors, guideline questions, and process gaps to the Quality Manager
- Stay current on CMS, payer, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifier, and ICD-10-CM updates
- Perform other assigned duties
- Follow company compliance, information security, and regulatory policies
Requirements:
- Bachelor’s Degree
- CCS, CPC, or COC certification required
- CPMA, COSC, CCC, or CASCC certification preferred
- Minimum 5 years coding experience
- Professional or hospital coding experience
- Thorough understanding of ICD-10-CM, HCPCS/CPT, OPPS, and APC
- Ability to code complex outpatient services, including interventional radiology, ambulatory surgery, emergency room, and observation
- Expertise in Medicare LCDs and NCDs
- Expertise in NCCI edits, MUEs, and facility modifiers such as 59/XS, 73/74, and 25
- Ability to write professional notes citing recognized coding and Medicare resources
- Prior coding audit, compliance review, RAC, or payer-side Payment Integrity audit experience preferred
- Experience reviewing operative reports for complex surgical procedures preferred
- Excellent verbal, written, and interpersonal communication skills
- Strong organizational skills, attention to detail, and accuracy
- Ability to work independently and in a team environment
- Flexibility and adaptability
- Superior coding audit and monitoring skills
- Excellent decision-making and sound judgment
- Strong technical knowledge and ability to learn new systems quickly
- Ability to complete tasks efficiently, resolve problems, and meet deadlines
- Proficiency in Microsoft Excel, PowerPoint, Outlook, and Word
Benefits:
- Exciting, fast-paced, and innovative work environment
- Opportunity to work closely with experienced healthcare consultants
- Exposure to multiple aspects of clients’ businesses
- Teamwork and time-management skill development
- Mentoring program with a senior-level professional advisor for junior-level employees
- Career growth and development opportunities
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