Job Description:
• Audit and review Behavioral Health claims to identify potential errors.
• Analyze data against payer policies, procedures, and regulatory requirements.
• Document findings clearly and professionally to support next steps.
• Recommend claim adjustments or recoveries when necessary.
• Collaborate with cross-functional teams to solve problems and drive improvements.
• Stay ahead of the curve on regulations, laws, and industry standards.
• Track and report audit findings, spotting trends and opportunities.
• Share your expert knowledge to guide teams on Behavioral Health payment integrity issues.
• Meet EXL’s productivity and quality goals while maintaining compliance with HIPAA and other regulations.
Requirements:
• Education: Bachelor’s degree in healthcare administration, business, finance, or a related field.
• Experience: 3+ years in Behavioral Health services (mental health and substance use disorder treatment).
• Credentials (Preferred): CCS, RHIA, RHIT, CPC, RN, MSW – bonus points if you have multiple!
• Expertise: Strong understanding of Behavioral Health standards, payer policies, and regulations.
• Bonus: Experience in Behavioral Health retrospective overpayment auditing.
• Ability to work independently in a fully remote environment.
• Strong time management and prioritization skills.
• A problem-solving mindset and ownership of results.
• Excellent communication skills (both written and verbal).
• Sharp analytical skills and great attention to detail.
• Proficiency in Microsoft Excel, Word, and OneNote.
Benefits:
• Up to 10% annual travel (for team meetings and limited client onsite engagements.)
• Professional development opportunities