Why join EXL?
At EXL, we’re more than just an analytics, operations management, and technology Company. We focus not only on our outstanding Team Members, but on our growing industry as well.
Headquartered in NYC, EXL has more than 27,000 professionals situated in locations throughout the United States, Europe, Asia, Latin America, and South Africa.
Our EXL Team Members receive the benefit of:
Valuable Compensation Package:
Work-Related Expense Reimbursement
Annual Discretionary Bonuses
Team Member Referral Bonuses
Comprehensive Health & Welfare Benefits:
Group Medical, Dental and Vision Benefits
Flexible Spending Accounts and Health Savings Accounts
Generous Paid Time Off, Sick Days and Holiday Pay
Group Life Insurance, LTD and 401k Retirement
Inviting Culture & Team-Oriented Philosophy:
Exciting Work Environment
Casual Dress Code
Monthly Team and Company Events
Team Member Appreciation Awards
Remote, Home-Based Opportunities
Upward Mobility Opporunities
The Quality Compliance Analyst position is a member of the Global Quality Process Excellence Team, dedicated to performing audits and supporting the education and professional development of clinical and non-clinical staff processes across the organization in accordance with client
requirements and the regulatory standards governing the applicable line of business.
Conduct research of laws, regulations, guidelines, contracts, policies and procedures, and other types of resources or documentation.
Analyze and interpret such information to effectively perform position responsibilities.
Participate in audit/risk assessment activities relative to Medicare Advantage, Medicaid and Commercial or Exchange healthcare products.
Identify and resolve deficiencies by training staff on requirements.
Provides an annual audit plan that identifies areas of opportunity.
Collects, prepares, reviews, and submits information, data and documents to the applicable Manager.
Coordinates, participates in and executes internal audit activities to systematically review specific functional areas of the organization for compliance with Medicare, Medicaid and specific client requirements.
Adapt or develop effective audit tools and reports as needed to effectively conduct, document, and communicate audit activities.
Work with operational functional unit leaders and staff to identify monitoring areas; collect, analyze, and interpret data and report results of monitoring initiatives.
Coordinate with or assist the QPE LAM in preparing status and operational monitoring reports for senior management and Compliance Committees. Compile data and analyze for accuracy identify any trends or issues and bring to Manager’s attention.
Develop corrective action plans (CAPs) as appropriate, determine root cause and impacts, track and monitor to ensure that actions taken effectively address short- and long-term corrections, validate that corrective actions are successfully implemented. Review and evaluate the effectiveness of corrective action plans and provide comprehensive follow-up to the Manager.
Other related duties as assigned to meet departmental and Company objectives.
Assists in conducting training needs analysis
Develops or assists in developing training aids, curriculum or criteria
Fosters positive relationships with all business areas, and encourages recommendations at all levels of the Company
Works in collaboration with the Health Integrated, an EXL company Quality Training team and other cross-functional areas to develop teaching aids, and successfully facilitate training activities
Continually evaluates effectiveness of training programs, recommends and/or develops revisions as needed
Maintains formal record of training activities and employee progress (track and trend)
Knowledge of clinical and non-clinical practices within a health plan and insurance provider environment.
Background as a high-level performer and Subject Matter Expert (SME) for the plan being audited.
Knowledge of internal policies and procedures, CMS, NCQA and URAC requirements in the health plan environment.
Critical thinking, ease in communicating in formal and informal settings, excellent documentation skills (Excel, Word, email, in-person).
Ability to work independently
Ability to analyze information and convert related activities into a comprehensive work plan with associated corrective action requirements, re-measurement for improvements as well as follow up documentation of education.
Ability to create and maintain a process improvement for all audit deficiencies, track and trend improvement or decline and manage the corrective action process accordingly.
Work Experience Requirements:
- Bachelor’s Degree or Associates Degree required
- RN, LPN, LCSW, LMHC or similar with current, unrestricted license required
- One to two years of experience in utilization review, quality assurance, discharge planning, or case management programs and/or a scope of practice that is relevant to the clinical area(s) addressed in the audit.
- One-year experience working in the applicable client’s payment system.
- One to two years directly related experience using InterQual, MCG, Behavioral Health or applicable criteria preferred.
- Preferred- Two years’ experience in auditing practices.
- Preferred- chart review experience highly preferred.
- Managed care experience preferred.