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Assistant Manager- Clinical Auditor at EXL Talent Acquisition Team

, , India -

Full Time

Start Date

Immediate

Expiry Date

11 Jun, 26

Salary

0.0

Posted On

13 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Auditing, Medical Claims Review, Documentation Accuracy, Billing Error Identification, Clinical Review, CMS Guidelines Compliance, Payer Policies, Regulatory Compliance, Best Practice Audits, Coding Inaccuracies, Revenue Leakage Identification, Corrective Action Reporting, Process Improvement, Collaboration, Quality Assurance, Trend Monitoring

Industry

Business Consulting and Services

Description

* Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation. * Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors. * Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards. * Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes. * Conduct best practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities. * Provide structured findings and audit reports with clear recommendations for corrective action and process improvement. * Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions. * Monitor trends in audit results and identify recurring issues requiring targeted education or intervention. * Support quality assurance initiatives by maintaining audit accuracy benchmarks and meeting productivity standards. * Participate in continuous improvement activities, including updates on CMS regulations, clinical guidelines, and payer policy changes.

Responsibilities

The role involves reviewing and auditing medical claims against patient records to ensure accuracy, identifying discrepancies, and validating diagnoses and procedures against industry standards. Responsibilities also include ensuring compliance with CMS guidelines and providing structured audit reports with recommendations for corrective action and process improvement.