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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
Work setup: Remote