Location: New York,NY, USA
Company Overview and Culture
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit
EXL Company is looking for an Auditor III - Home Health. This a full-time, work from home opportunity.
In this fully remote position as a Home Health Auditor you will apply your expert clinical knowledge in the auditing of Home Health medical records to validate or revise the Provider's billed services. You will utilize industry and EXL proprietary tools in the Home Health review process, and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive clinical and industry knowledge to identify audit trends.
Key Responsibilities:
* Conduct Home Health reviews to verify the accuracy of the billed services based on CMS guidelines.
* Apply CMS guidelines during medical record review to ensure services provided are supported. In addition, utilize industry and proprietary tools to maximize overpayment identifications.
* Document audit results in a clear, concise, and effective manner using CMS Home Health, Oasis and ICD-10 CM Guidelines.
* Utilize proprietary workflow systems and encoder tools (e.g., Decision Health, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly.
* Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals.
* Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements.
* Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.
Qualifications:
* LPN, Registered Nurse with Associate's or Bachelor's degree preferred
* 3+ years of acute care nursing experience with preference given to candidates with OASIS or Coding Certification.
* Prior Home Health auditing experience.
Knowledge, Skills, Behaviors:
* Extensive knowledge of PDGM and PPS payment methodologies.
* Experience with encoder tools (Decision Health, ICD-10, Webstrat).
* Works independently in a remote environment and delivers exceptional results during EXL core business hours.
* Possesses excellent time management and work prioritization skills.
* Takes ownership of problem solving.
* Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
* Proficient in Excel, Word, and OneNote with general computer literacy.
* Passionate about Home Health Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration, inclusiveness, and support.
EEO/Minorities/Females/Vets/Disabilities
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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.
Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.
Application & Interview Impersonation Warning - Purposely impersonating another individual when applying and / or participating in an interview in order to obtain employment with EXL Service Holdings, Inc. (the Company ) for yourself or for the other individual is a crime. We have implemented measures to deter and to uncover such unlawful conduct. If the Company identifies such fraudulent conduct, it will result in, as applicable, the application being rejected, an offer (if made) being rescinded, or termination of employment as well as possible legal action against the impersonator(s).
EXL may use artificial intelligence to create insights on how your candidate information matches the requirements of the job for which you applied. While AI may be used in the recruiting process, all final decisions in the recruiting and hiring process will be taken by the recruiting and hiring teams after considering a candidate's full profile. As a candidate, you can choose to opt out of this artificial intelligence screening process. Your decision to opt out will not negatively impact your opportunity for employment with EXL.
Other details
* Pay Type Salary
* Min Hiring Rate $75,000.00
* Max Hiring Rate $85,000.00
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