Outpatient- Quality Manager

ExlService Holdings, Inc.; Northern (KY); Hybrid; USD 100,000 - 120,000; Full time

Job summary

ExlService Holdings, Inc. is seeking a leader to manage a team of outpatient quality analysts responsible for auditing auditor-completed outpatient facility coding reviews, validating accuracy, and ensuring compliant coding, billing, and documentation outcomes.

The role requires strong leadership and analytical skills with expertise in ICD-10-CM, CPT, HCPCS, modifiers, OPPS/APC reimbursement, NCCI edits, LCD/NCD requirements, and payer policies. 100% remote, U.S.-based.

Qualifications

• Leadership experience in outpatient quality auditing.
• Expertise in ICD-10-CM, CPT and HCPCS coding rules.
• Familiarity with OPPS/APC reimbursement and NCCI edits.
• Knowledge of LCD/NCD requirements and payer policies.

Responsibilities

• Directly manages a team of outpatient quality analysts.
• Reviews auditor-completed outpatient facility coding audits.
• Validates audit accuracy and ensures correct coding, billing, reimbursement and documentation.
• Leads with strong analytical skills to uphold standards and improve processes.

Skills

Leadership

ICD-10-CM

CPT

HCPCS

OPPS/APC

NCCI edits

LCD/NCD

Payer policies

Audit tools

Quality review standards

Job description

The role directly manages a team of outpatient quality analysts responsible for reviewing auditor-completed outpatient facility coding audits, ATA audits, validating audit accuracy, and ensuring accurate coding, billing, reimbursement, and documentation outcomes. The ideal candidate demonstrates strong leadership and analytical skills, along with expertise in ICD-10-CM, CPT, HCPCS, modifiers, OPPS/APC reimbursement, NCCI edits, LCD/NCD requirements, payer policies, audit tools, and outpatient quality review standards.

Salary Range: $100,000 – $120,000, based on experience, skills, and qualifications.

Location: 100% Remote, U.S.-based.

Travel: Limited travel may be required for team meetings.

A brief outpatient coding/auditing assessment may be included as part of the interview process.

For more information on benefits and what we offer, please visit us at https://www.exlservice.com/us-careers-and-benefits.

For more information on benefits and what we offer, please visit us at https://www.exlservice.com/us-careers-and-benefits.