Job title: Senior Executive

Company: EXL IT service management

Job description: Overview 1. Responsible for reviewing/auditing claims and identifying the findings based on the billing and checking on compliance with CMS guidelines. Qualifications: 1. BSc Nursing, USRN with minimum 3 years of clinical experience. Experi

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 of the 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 a 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 ere 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 Client meetings, and 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: Thu, 14 Jul 2022 22:32:27 GMT

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