The role directly manages a team of outpatient quality analysts responsible for
reviewing auditor-completed outpatient facility coding audits, ATA audits,
validating audit accuracy, and ensuring accurate coding, billing, reimbursement,
and documentation outcomes. The ideal candidate demonstrates strong leadership
and analytical skills, along with expertise in ICD-10-CM, CPT, HCPCS, modifiers,
OPPS/APC reimbursement, NCCI edits, LCD/NCD requirements, payer policies, audit
tools, and outpatient quality review standards.
Salary Range: $100,000 – $120,000, based on experience, skills, and
qualifications.
Location: 100% Remote, U.S.-based.
Travel: Limited travel may be required for team meetings.
A brief outpatient coding/auditing assessment may be included as part of the
interview process.
For more information on benefits and what we offer, please visit us at
https://www.exlservice.com/us-careers-and-benefits.
For more information on benefits and what we offer, please visit us at
https://www.exlservice.com/us-careers-and-benefits.
RESPONSIBILITIES
Actively drive the execution and ongoing improvement of outpatient coding
quality review programs, including initial audits, appeals, targeted reviews,
provider- or concept-specific reviews, and ATA audits.
Manage day-to-day outpatient quality review operations, including workflow
distribution, inventory, QA aging, productivity, timeliness, client SLAs,
quality expectations, and internal standards.
Provide direct supervision to outpatient quality analysts through coaching,
feedback, performance management, one-on-ones, training, development
planning, and ongoing upskilling.
Analyze audit accuracy, productivity, QA inventory, defect trends, root cause
analysis, auditor performance, documentation patterns, and quality
performance metrics to take action that improves team performance and overall
quality results.
Perform ATA audits as part of the team’s outpatient quality review
activities, ensuring audit determinations, documentation support, rationales,
and quality outcomes are accurate, consistent, and aligned with client and
program expectations.
Ensure RCA categories are marked appropriately and that recurring trends
result in timely follow-up, coaching, clarification, process correction, or
escalation as needed.
Lead regular calibration with outpatient quality analysts to promote
consistent review decisions, aligned rationale documentation, appropriate RCA
selection, and consistent application of coding and payer guidance.
Partner with Operations, Training, Technology, clients, and global partners
to drive consistency, resolve quality or operational issues, and support
outpatient audit quality solutions.
Support program implementations and operational initiatives by defining
outpatient quality expectations, review criteria, sampling approaches,
workflow needs, reporting requirements, and quality control processes.
Identify responsible AI-in-the-workflow opportunities that improve audit
quality, consistency, efficiency, trend identification, documentation
support, and team productivity while maintaining appropriate human review,
compliance, and data security expectations.
Monitor CMS, payer, LCD/NCD, NCCI, OPPS/APC, CPT, HCPCS, modifier, and
ICD-10-CM guideline updates to ensure quality reviews remain compliant and
current.
Conduct all job functions and responsibilities in accordance with all company
Compliance, Information Security, and Regulatory policies, procedures, and
programs.
QUALIFICATIONS
Experience
CCS, CPC, RHIT, RHIA, or other relevant coding credential required; CCS or
CPC preferred.
Minimum 5 years of outpatient facility coding, auditing, or quality review
experience, with demonstrated understanding of ICD-10-CM, CPT, HCPCS,
modifiers, OPPS, APC reimbursement, and outpatient payment methodologies.
Prior leadership, supervisory, quality management, or team lead experience
required.
Experience applying Medicare Local Coverage Determinations (LCDs), National
Coverage Determinations (NCDs), NCCI edits, payer policies, and medical
necessity requirements.
Experience with outpatient audit operations, quality assurance processes,
root cause analysis, coaching, and performance improvement.
Skills & Competencies
Strong outpatient coding expertise across complex facility services such as
interventional radiology, ambulatory surgery, emergency department,
observation, infusion/injection, wound care, and diagnostic services.
Proficient in modifier application, CPT/HCPCS coding, ICD-10-CM coding, NCCI
edits, MUEs, and appropriate Medicare and payer-specific guidelines.
Ability to evaluate audit accuracy, determine whether findings and
no-findings are supported, and validate clear rationale based on
documentation and authoritative coding guidance.
Ability to write professional quality notes citing Official Coding
Guidelines, CPT/HCPCS guidance, Coding Clinic, AMA CPT Assistant, CMS
guidance, LCD/NCD policies, and other recognized sources as appropriate.
Strong leadership, coaching, and mentoring skills with the ability to develop
outpatient quality analysts and support consistent audit decision-making.
Excellent verbal and written communication skills, including the ability to
explain complex coding and quality concepts clearly.
Strong analytical, root cause analysis, decision-making, and problem-solving
skills.
Strong organizational skills, attention to detail, and ability to manage
competing priorities, inventory, and deadlines.
Ability to work independently and collaboratively with Operations, Training,
Technology, clients, and global partners.
Demonstrated flexibility, adaptability, accountability, and sound judgment in
a fast-paced audit environment.
Strong technical knowledge and ability to learn new audit tools, reporting
platforms, and workflow systems quickly.
Digital mindset with the ability to appropriately leverage approved
AI-enabled tools and workflow technology to enhance quality monitoring,
reporting, root cause analysis, calibration preparation, and operational
efficiency.
Proficiency with Excel, PowerPoint, Outlook, Word, and audit productivity or
reporting tools.
Strong interpersonal skills with the ability to promote accountability,
collaboration, and consistent quality practices across the team.
What We Offer
EXL Health offers an exciting, fast paced, and innovative environment, which
brings together a group of sharp and entrepreneurial professionals who are
eager to influence business decisions. From your very first day, you get an
opportunity to work closely with highly experienced, world class Healthcare
consultants
You can expect to learn many aspects of businesses that our clients engage
in. You will also learn effective teamwork and time-management skills—key
aspects for personal and professional growth
We provide guidance/coaching to every employee through our mentoring program
wherein every junior-level employee is assigned a senior-level professional
as an advisor
The sky is the limit for our team members. The unique experiences gathered at
EXL Health sets the stage for further growth and development in our company
and beyond
The posted base salary range is the hiring base salary range for this role.
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.