Senior Executive

Job Description

Job Description_ Contingency _Home Health India RN Job Name Senior Executive Position Title Senior Executive - Clinical Auditor Band A2 Reporting To ERP Full Position ID: Assistant Manager Location/Site: EXL India Overview 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 Minimum 3 years of clinical/hospital experience is mandatory Communication Strong written (documentation) and oral communication skills Experience Minimum 3 years of clinical experience. Auditing experience (Optional) 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. Show more Show less