Company Overview and Culture 

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.

About EXL Health

We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem.  Technology, data and analytics are at the heart of our solutions.  We collaborate closely with clients to transform how care is delivered, managed and paid.  

EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid.  Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions.  With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.   

We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.

EXL Health is looking for a DRG Clinical Validation Audit (CVA) Manager. This is 100% remote work from home opportunity!

Are you an experienced Payment Integrity leader looking for the next step in your career path?  Is it time for a change?  Explore this opportunity with a new, exciting, and dynamic growth-oriented team.

In this role you will collaborate with a diverse group of Payment Integrity Audit Program leaders, and our operational team members to manage the day-to-day operations to ensure timely completion of each step of the complex audit process from selection to recovery. The successful candidate will be passionate, quality focused and have a diverse clinical background and a background in clinical audit. 

The successful candidate will manage a team of CVA auditors, collaborate with other areas to identify and work on resolution for areas of potential risk or concern that impede optimal recovery results. Passionate about Payment Integrity, and a desire to work in an environment that thrives on teamwork, excellence, collaboration, inclusiveness, and support.

Job Responsibilities:

• Support work environment to facilitate employee satisfaction, people development, continuous process improvement, quality, productivity, and client satisfaction.
• Monitor Key Performance Indicators to ensure auditor productivity requirements are being met
• Collaborate with DRG SME and Appeals Auditors to continue to refine and develop the concepts and potential training.
• Assist with auditor questions and day to day process questions
• Lead provider/client peer-to-peer discussions and respond to inquiries regarding audit results, program guidelines, dispute responses, and other general clinical questions
• Identify and assist with implementing process enhancements that optimize recovery opportunities
• Inventory management for the CVA program to ensure audits compliant with regulatory timeframes.
• Work with team members to solve problems with aging inventory or other operational issues
• Assist with creating and maintaining Statement of Policy (SOP) to ensure compliance with client Statement of Work
• Ensure compliance with internal policies and procedures, external regulations, and information security standards
• Assist with hiring, on-boarding, and training as appropriate for new employees
• Capable of building and maintaining strong interdepartmental working relationships
• Support operational projects and activities to drive process improvement which may include participation in technical/business discovery conversations, completion of root cause analysis to identify and solve for operational challenges/barriers to program success

Qualifications:

• 5+ years of experience Payment Integrity Complex Audit & Recovery programs preferred
• CVA expert with in-depth knowledge of complex reimbursement methodologies
• Experienced remote team manager for a diverse group of audit professionals
• Strong organizational, project management, and analytical skills, with attention to detail
• Excellent oral and written communication skills

Education and Required Certification:

• Current unrestricted nursing license, RN
• RHIT, CCS or CPC preferred.

Work Experience Requirements:

• Strong leadership and organizational skills, with the ability to develop work plans, action plans, and standard operating procedures
• MS-DRG and APR DRG experience
• Advanced Excel skills preferred
• Proficient with Microsoft Word & Power Point

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 advisors.
• 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.
• Benefits we offer are Healthcare, Vision, Dental and 401k options.