Quality Analyst - Outpatient, Healthcare

This is a remote opportunity. The Quality Analyst oversees work performed by the Outpatient audit program to ensure that EXL’s standard of accuracy is met. Audits are performed by validating the accuracy of the coding billed in relation to the medical documentation. The coding auditor determines if a discrepancy exists in the coding and documents the findings. The Quality Analyst undertakes a quality review of random and targeted coding audits to check the accuracy and completeness of audits performed. 

A brief coding/auditing assessment may be included as part of the interview process

Salary Range: $85,000 – $92,000 (based on experience, skills, and qualifications)
Location: 100% Remote (U.S.-based)

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

What You’ll Be Doing:

• Responsible for reviewing the accuracy and consistency of coding auditors to ensure audits are appropriately marked for findings and no findings.

• Validate that audit determinations, documentation support, and rationales are accurate, consistent, and aligned with client and program expectations

• Review medical records to determine if facility coding is accurate

• Assign accurate root cause (RCA) categories to identify errors and flag recurring trends to the Quality Manager

• Mentor coding auditors and provide feedback when required

• Perform quality reviews for initial audits and appeals

• Manage assigned QA inventory and meet established quality, productivity, and turnaround expectations

• Identify overpayment and underpayment findings, including opportunities outside the audit concept, and support audit reporting and trend analysis

• Participate in regular calibration sessions to support consistent review decisions, rationale documentation, and application of coding and payer guidance

• Recommend process changes to improve quality and performance

• Escalate recurring errors, guideline questions, or process gaps to the Quality Manager for follow-up

• Stay current on CMS, payer, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifier, and ICD-10-CM updates and apply them consistently in quality reviews

• Perform other duties as assigned

• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs

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What You’ll Bring:

• CCS, CPC, or COC certified

• CPMA, COSC, CCC, or CASCC certification preferred

• Minimum 5 years coding experience: Professional or hospital coding with thorough understanding of ICD-10-CM coding; HCPCS/CPT coding systems; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC)

• Must have the ability to code a wide variety of complex outpatient services such as interventional radiology, ambulatory surgery, emergency room and observation

• Expertise in Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)

• Expertise in NCCI edits, Medically Unlikely Edits (MUEs), and facility modifier application (e.g., 59/XS, 73/74, 25) following appropriate Medicare guidelines under OPPS and ASC payment methodologies

• Ability to write professional notes quoting resources such as the Official Coding Guidelines, ICD-10 Coding Handbook, AHA Coding Clinic, AHA Coding Clinic for HCPCS, CPT Assistant, the Medicare Claims Processing Manual, and/or other recognized sources

• Prior coding audit, compliance review, RAC, or payer-side Payment Integrity audit experience preferred

• Experience reviewing operative reports for complex surgical procedures preferred, including orthopedic (arthroscopy, total joint arthroplasty, spinal fusion, fracture care, hardware removal), cardiac/vascular (cardiac catheterization, angioplasty, pacemaker insertion, vascular surgery), and multi-specialty/general surgery

• Excellent verbal, written, and interpersonal communication skills.

• Strong organizational skills, attention to detail, and a high degree of accuracy across varied responsibilities.

• Ability to work in a team environment and independently as needed.

• Demonstrate flexibility and adaptability.

• Superior coding audit and monitoring skills.

• Excellent decision-making skills and sound judgment, including independent decision-making in a wide variety of situations.

• Strong technical knowledge and ability to learn new systems quickly.

• Ability to complete tasks efficiently, resolve problems, and meet deadlines.

• Proficient in Microsoft Excel, PowerPoint, Outlook, and Word.

What We Offer You:

• EXL Health offers an exciting, fast-paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world-class healthcare consultants

• You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills—key aspects for personal and professional growth

• We provide guidance/coaching to every employee through our mentoring program wherein every junior-level employee is assigned a senior-level professional as an advisor

• The sky is the limit for our team members. The unique experiences gathered at EXL Health set the stage for further growth and development in our company and beyond

At EXL Health, you’ll not only do meaningful work—you’ll grow your career, expand your skills, and be part of a team that values your contribution.

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.