3635764-Senior Executive

JOB DESCRIPTION ;The Clinical Auditor performs reviews, analyzes, and codes documentation from medical records that determines payments.This position performs highly technical and specialized functions, and the primary function of this position is to perform a thorough review of patient encounters to assess for completeness and accuracy of provider documentation and ICD-10-CM, CPT and HCPCS coding.The coding function also ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines.ESSENTIAL CRITERIA: ;Bachelor's degree (or equivalent) in Nursing.NCLEX certification - Active(USRN)Able to apply analytical and critical thinking to record reviews.Required comprehensive clinical knowledge and strong clinical experience.All certifications/License should be active. ;DESIRABLE CRITERIA: ;Certified professional coder (CPC) - AAPCAuditing experience on US Medical Coding.Knowledge in Microsoft outlook/excel/wordExposure on 3M software and NLP tool. ;PRIMARY RESPONSIBILITIES:Performs clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding.Integrates coding principles in performance of medical audit activity and educates as needed on those principlesUpon completion of medical record audit, compiles detailed findings and prepares client reports, when needed.Coordinates with client to ensure patient data is received and processed for all scheduled audit workCommunicate proper volume to support invoicing.Provides feedback and process improvement recommendations to appropriate leadership team and participates in workgroups/committee meetings and process improvement solutions as required.Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of latest trends in the field of expertise. ;ADDITIONAL RESPONSIBILITIES:Participates in and/or leads inter-departmental process improvement initiatives.Identifies compliance risks and financial opportunities based on chart reviews.Prepares reports and executive summaries as required by management regarding audit results, process improvement recommendations, and systemic billing errors.Adheres to established productivity standards, participates in departmental performance improvement activities and work level.Communicates and works with all internal and external customers.Performs other duties as assigned.EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration - and we've been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that's unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It's our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we're some of the best in the business. Contact us to see how we can help you achieve your goals.