This is a remote position where the SNF/PDPM Quality Analyst is responsible for
conducting quality reviews of completed audits, ensuring compliance with CMS
regulations, internal policies client requirements, and audit methodologies. The
role evaluates the accuracy, consistency, and defensibility of audit
determinations, identifies trends and process improvement opportunities, and
contributes to overall quality performance and operational excellence.
Hourly Range: $36.00 – $47.45
Location: 100% Remote (U.S.-based)
Up to 10% annual travel (for team meetings and limited client onsite
engagements.)
For more information on benefits and what we offer please visit us
at https://www.exlservice.com/us-careers-and-benefits
[https://www.exlservice.com/us-careers-and-benefits]
RESPONSIBILITIES
Quality Review and Audit Oversight: Demonstrates expertise in the following:
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
Performance Management: Consistently contributes to client saving/internal
revenue goals
Achieves productivity and quality goals
Team Work: Understands duties, team goals, and consistently achieves performance
required
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.
Identify and communicate facility and provider specific issues that impact
audits.
Continuous Improvement / Education
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
QUALIFICATIONS
Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse
license in good standing in the state that you reside
Minimum of 5 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
Knowledge & Skills
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
What We Offer You:
A fast-paced, innovative environment with a team of sharp, driven
professionals
Remote work flexibility and a chance to impact healthcare delivery nationwide
Opportunities for growth and mentorship through our structured coaching
program
A collaborative culture where your ideas and insights are valued
Real opportunities for advancement—your future here is what you make it!
At EXL Health, you’ll not only do meaningful work—you’ll grow your career,
expand your skills, and be part of a team that values your contribution.
Ready to take your career to the next level? Apply today!
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.