Job title: Senior Executive
Company: EXL Service
Job description: Job Description:
Overview * Responsible for reviewing/auditing claims and identifying the findings based on the billing and checking on compliance with CMS guidelines.
Qualifications: * Bsc Nursing, USRN with minimum 3 years of clinical experience.
Experience: * Previous experience in clinical audits is preferred.
- In depth clinical knowledge and skill set to identify various trends in clinical review.
- Understanding of ICD-10 coding and application of knowledge in PDPM auditing.
- Expertise in various clinical conditions, treatments, and diagnostic tests, preferably for Nursing home patients.
- Knowledge in Minimum data set (MDS) and CMS Medicare policies, is preferable.
- Understanding the need for various rehabilitation services required based on clinical conditions and identifying the services that were apt and rendered to Nursing home patients timely.
Communication: * Strong written (documentation) and good oral communication skills
Working Hours: * 40 hours per week as Full-time employee
- Shift time: 08:00AM TO 05:00PM IST
- Weekends Off
Telecommuter/Internet requirements, if applicable: * High-Speed internet connection at home, must be broadband
- Must understand and adhere to telecommuter policy
- Required attention to detail for clinical data and specific requirements for Medicare patients.
- Excellent communication skills including writing finding/incomplete letters, and business email communication with clients.
- Able to correlate recent hospital admitting diagnosis and reason for SNF admission, and able to conclude the review based on the clinical presentation, care rendered, rehabilitation and Nursing services utilized.
- Ensure adherence to Client SOW, and audit review criteria.
- Ensure reviews are performed per Client expectations
- Ensure integrity and honesty while performing reviews
- Ex : Medical records should be thoroughly reviewed prior to concluding the audit review outcome
- Ensure adhere to Compliance while performing reviews
- Ensure to identify and provide appropriate reports on anomalies, and issue scenarios while reviewing audits.
- Provide all the info required for Client communication
- Provide all the info to answer all the clinical queries as requested by the Client within 24 hours of the time frame.
- Provide all the required info to the Client /lead on clinical, production, and quality within TAT.
- Provider, all the required reports to maintain good Client communication and ensure Client satisfaction
- Available for a Client meeting, client calls as required on program performance.
- Ensure Client focus is the most important priority
- Ensure productivity and quality numbers committed to the Client are adhered to and achieved.
- Ensure every report to the Client is sent as per TAT and possible prior to TAT.
- Ensure delivery of each and every aspect of the audit process like Selections, inventory, audit, QC, appeals, uploads, and reporting is within TAT as applicable
- Ensure inventory is worked as per Client expectations
- Ensure Client productivity and quality targets for the team are adhered to, and work towards exceeding the same.
- Ensure productivity and quality targets for the team are adhered to
- Ensure QC % is delivered based on the agreed QC % with the Client
Expected salary:
Location: Chennai, Tamil Nadu
Job date: Sat, 09 Jul 2022 07:04:48 GMT
Apply for the job now!