Outpatient Expert - Manager

Company Overview and Culture
EXL (NASDAQ: EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth. Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect. Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents. For information, visit www.exlservice.com.

EXL Health Analytics is looking for an Outpatient/Ambulatory Payments Classifications (APC) SME. This is a remote, work from home opportunity.

The successful candidate will manage a team of expert auditors, responsible for reviewing Outpatient and APC selected cases for appropriate coding and reimbursement. The successful candidate will him/herself possess the coding skill set and sufficient experience to help train and guide a team of expert coders by demonstrating mastery of the coding guidelines, coding clinics, and support tools. The successful candidate will also possess strong working knowledge of CMS rules guidelines and is abreast of regulatory changes.

Responsibilities:

• Lead a team of coding auditors, reviewing selected outpatient claims for appropriate coding and reimbursement.
• Demonstrate mastery of the coding guidelines, CPT classification systems, billing and reimbursement process and support tools.
• Possess a strong working knowledge of NCCI edits and stay abreast of regulatory changes.
• Actively participate in the selections process initiatives, monitor program performance, review results and fine-tune selections queries with the analytics team.
• Ensure audit staff is trained, aligned, and able to achieve established goals and performance requirements.
• Establish a quality assurance process, perform QC on team work, provide feedback and coach the team in areas needing attention.
• Perform random and focused quality assurance audits, ensuring staff receives monthly feedback and performance updates.
• Review and address all facility disputes effectively.
• Provide daily support and direction of program activities.
• Participate in client calls and represent the program on outpatient coding subject matter expertise.
• Manage the audit program, client relationships, and assist with new audit program implementation and enhancements.

Qualifications:

• CCS-P - Certified Coding Specialist Physician, CPC – Certified Procedural Coder, or CCS - Certified Coding Specialist.
• RHIT - Registered Health Information Technologist.
• 10+ years’ experience with outpatient auditing/coding.
• Expert knowledge of ICD-9, ICD-10, CPT and HCPCS coding guidelines.
• Experience with encoder tools (TrueCode, 3M, Webstrat, Pricers).
• Strong leadership and organizational skills, with 3-5 years of supervisory experience.
• Excellent verbal/written communication skills, with the ability to lead training and team calls.
• Experience with programs such as Excel, PowerPoint, Outlook, and Word.

What we offer:

• An exciting, fast-paced and innovative environment with a group of sharp and entrepreneurial professionals.
• Opportunities to learn about various aspects of our clients' businesses.
• Guidance and coaching through our mentoring program.
• Growth and development opportunities within the company and beyond.

EEO/Minorities/Females/Vets/Disabilities

Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region-specific benefits.

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