Job Description_ Contingency _Home Health USRN
Job Name
Senior Executive
Position Title
Senior Executive - Clinical Auditor
Band
A2
Reporting To
Assistant Manager
Location/Site:
EXL India
US Registered Nurse with minimum 3 years of clinical experience and skillset, responsible for reviewing/auditing claims with medical record and identify the findings based on the billing. Performs best practice reviews and identify areas for improvement. Check on compliance with CMS guidelines
- Qualifications:
- Bachelor's degree in nursing
- Active State Nursing certification is Mandatory
- Active NCLEX certification is Mandatory
- Minimum 3 years of clinical/hospital experience is mandatory
- Experience:
- Minimum 3 years of clinical experience.
- Auditing experience (Optional)
- Communication:
- Strong written (documentation) and oral communication skills
- Working Hours:
- 40 hours per week as Full-time employee
- Shift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)
- Weekends: Off
- Telecommuter/Internet requirements, if applicable:
- High Speed internet connection at home, must be broadband
- Must understand and adhere with telecommuter policy
- Skills and abilities:
- Familiarity with basic medical terminology and concepts used in care management.
- Ability to effectively participate in a multi-disciplinary team including internal and external participants.
- Should have a good understanding of US healthcare system and management.
- Perform audit based on clinical knowledge while reviewing the medical record
- Demonstrate learning skills during process training and in advancing career
- Perform quality assurance reviews to assess comprehension of training efforts.
- Ensure to process the audit with accountability
- Ensure to view all documented system information as well as any additional records/data presented to support a determination or recommendation.
- Condenses all clinical information into a clear and precise clinical picture while taking a final decision.
- Pro-actively and consistently engage in enhancing process/work knowledge and delivery the work with high values.
- Actively update process knowledge and follow the new change in process.
- Be ready to analyze the errors and if required approach to quality team for further clarification.
- Maintain a professional work environment.
- Follow every aspect of SOP without fail.
- Complete received Audits with Quality.
- Achieve expected Quality and production target.
- Follow project-related protocols and instructions.
- Update all the logs like productivity, Clarification log, and any other logs applicable daily.
- Complete alignment with Manager /TL in terms of program delivery.
- Responding to all emails promptly without fail.
- Ensure compliance of the entire team.
