Senior Executive - Training And Quality

EXL; Chennai; On-site; INR 540,000 - 740,000; Full time

Job summary

EXL in Chennai is seeking an experienced Nurse Auditor to lead nurse auditors and contract auditors, ensuring daily operations meet productivity and quality standards. You will review best practices, guide reviewers across clinical audit, QC, and dispute handling, and verify patient and insurance data to flag overpayments.

Strong written and oral communication, hospital experience, and knowledge of US care management are essential.

Qualifications

• Bachelor's degree in nursing and active state nursing certification.
• Must have 4 years of clinical/hospital experience.
• Familiarity with US healthcare system and care management.

Responsibilities

• Manage nurse auditors and contract auditors to ensure productivity and quality.
• Perform best practice reviews and identify areas for improvement; train reviewers.
• Verify patient information and insurance details; identify overpayments and contracts.

Skills

Nurse auditing

Auditing experience

Communication

Microsoft Office

Computer literacy

Medical terminology

Education

Bachelor’s degree in nursing

Job description

Job Description:

• Responsible for managing Nurse auditors and other contract auditors to ensure smooth operations of daily activities and ensuring that audit productivity and quality standards are met.
• Performbest practice reviewsand identify areas for improvement. Performs beyond one role among Clinical auditor, QC and dispute. Training and guiding reviewers for enhancement

• Verifying the patient information, other insurance information, Validating the paid information and contract to identify the overpayments.

Responsibilities

Qualifications:

1. Bachelor’s degree in nursing
2. Active State Nursing certification is Mandatory
3. Minimum 4 years of clinical/hospital experience is mandatory

Communication:

• Strong written (documentation) and oral communication skills

Experience:

1. Minimum 4 years of clinical experience.
2. Auditing experience (Optional)

Working Hours:

1. 40 hours per week as Full-time employee
2. Shift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)
3. Weekends: Off

Telecommuter/Internet requirements, if applicable:

1. High Speed internet connection at home, must be broadband
2. Must understand and adhere with telecommuter policy

Qualifications

Computer Literacy

Microsoft Office

Quality Auditing experiencce
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.

Requirements