Quality Analyst - Skilled Nursing Facility (SNF) / Patient-Driven Payment Model (PDPM)

A brief coding/auditing assessment may be included as part of the interview process

Salary Range is $60,100 to $98,700 plus bonus

For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

The posted range is the hiring range for this role - a subset of the broader range available to employees over time - and reflects base salary across our national hiring scale. Final offers are based on several factors, including the candidate''s skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position. The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.

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 54,000 employees spanning six continents. For more information, visit www.exlservice.com.

EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL's Human Resources team, as well as our hiring managers.

• Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license in good standing in the state that you reside
• 5 plus years' experience with SNF clinical, MDS 3.0 completion, PDPM reimbursement methodology, quality assurance, auditing, and/or related experience
• Advanced knowledge of MDS 3.0 coding guidelines, skilled nursing facility (SNF) levels of care, and PDPM reimbursement
• Previous experience/exposure to the billing of HIPPS codes
• Experience reviewing audit findings, conducting quality revises, or performing compliance monitoring activities
• Experience with: Excel, PowerPoint, Outlook, and Word
• Experience with Encoder tools such as 3M
• Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)
• Must be detail oriented
• Must have excellent verbal and written communication skills
• Must be self-directed and able to work with minimum oversight

Quality Review and Audit Oversight:

• Perform quality reviews of completed SNF/PDPM audits to validate coding accuracy, reimbursement determinations, supporting documentation, and audit rationale
• Ensure audit findings align with CMS guidelines, RAI Manual requirements, PDPM regulations, client requirements, and departmental procedures
• Document quality review findings clearly and accurately
• Identify quality trends, recurring audit errors, and opportunities for process improvement
• Provide constructive written feedback to auditors
• Acheives productivity and quality goals
• Demonstrates awareness of goals by achieving performance requirements (self-accountability)
• Responds timely to emails and meeting requests (is in attendance as scheduled/requested)
• Actively participates in discussions and Team Meetings, providing suggestions of improvement or volunteers when needed
• Adhere to all EXL Health policies and procedures
• Report any problems in the audit or quality process to Quality Manager for resolution.
• Participate in workflow improvement initiatives
• Support development and maintenance of standard operating procedures and quality tools
• Attends training sessions to help program improve performance
• Maintain current knowledge of CMS regulations, PDPM reimbursement methodology, MDS 3.0 requirements, and industry best practices
• Monitor regulatory changes affecting SNF/PDPM auditing activities

Quality Review and Audit Oversight:

• Perform quality reviews of completed SNF/PDPM audits to validate coding accuracy, reimbursement determinations, supporting documentation, and audit rationale
• Ensure audit findings align with CMS guidelines, RAI Manual requirements, PDPM regulations, client requirements, and departmental procedures
• Document quality review findings clearly and accurately
• Identify quality trends, recurring audit errors, and opportunities for process improvement
• Provide constructive written feedback to auditors
• Acheives productivity and quality goals
• Demonstrates awareness of goals by achieving performance requirements (self-accountability)
• Responds timely to emails and meeting requests (is in attendance as scheduled/requested)
• Actively participates in discussions and Team Meetings, providing suggestions of improvement or volunteers when needed
• Adhere to all EXL Health policies and procedures
• Report any problems in the audit or quality process to Quality Manager for resolution.
• Participate in workflow improvement initiatives
• Support development and maintenance of standard operating procedures and quality tools
• Attends training sessions to help program improve performance
• Maintain current knowledge of CMS regulations, PDPM reimbursement methodology, MDS 3.0 requirements, and industry best practices
• Monitor regulatory changes affecting SNF/PDPM auditing activities