Jobs at EXL

Audit inpatient (IP) DRG records to meet quality and production targets. Follow SOPs and project protocols, complete audits accurately, update productivity and clarification logs daily, escalate and identify trends, coordinate with Manager/TL, ensure team compliance with HIPAA and OIG, and maintain timely email communication. Requires strong Excel skills, flexibility, and good communication.

Perform timely audits of medical records and insurance claims to verify documentation, coding (ICD/CPT/HCPCS), and medical necessity. Identify and resolve discrepancies, collaborate with providers/coders, ensure HIPAA/CMS compliance, produce audit reports, support internal QA, and meet quality and production targets.

Lead quality audits of coded medical records to ensure accurate CPT, ICD-10-CM, and HCPCS coding and payer compliance. Identify errors and trends, provide feedback, support training and process improvements, enforce HIPAA/OIG compliance, and manage and motivate a coding quality team.

Act as dedicated Scrum Master for a data engineering pod: run agile ceremonies, remove blockers, protect capacity, translate migration and AI initiatives into prioritized backlog, and coordinate downstream Tableau support while serving as a technical sounding board for engineers.

Make outbound calls to US insurance companies, providers, and TPAs to follow up on pending/denied claims, resolve denials and payment discrepancies, document interactions, meet productivity and quality targets, and ensure HIPAA/OIG compliance while coordinating with internal teams and management.

Design, build, and optimize Databricks-based lakehouse solutions for financial crime use cases. Manage Databricks workspaces, clusters, Unity Catalog, and jobs. Develop scalable batch and streaming PySpark/Spark SQL pipelines (Kafka/Event Hubs/Kinesis) using Delta Lake, DLT, and Medallion architecture. Ensure data governance, performance tuning, error handling, and integration with cloud storage (ADLS/S3/GCS) and secret management.

Perform US healthcare accounts receivable calling to obtain claim status, follow up on unpaid claims, verify insurance details, ensure HIPAA-compliant communications, post cash and adjustments, escalate difficult collections, handle patient billing queries, and meet daily/weekly/monthly productivity and quality targets while working assigned night shift remotely.

Manage US healthcare accounts receivable by contacting insurers, resolving claim status, following up timely to prevent revenue loss, posting payments/adjustments, handling patient billing queries, meeting productivity and quality targets, and adhering to HIPAA/confidentiality rules.

Perform high-quality audits of outpatient surgery coding, follow SOPs and project protocols, meet quality and productivity targets, update daily logs, escalate trends/issues, ensure HIPAA/OIG compliance, communicate promptly with managers, and support auditing and denial management processes.

Perform accurate CPT and ICD-10-CM coding, analyze denied claims, contact provider offices to resolve denials, document outcomes and update claim status, follow up to maximize reimbursement, adhere to client guidelines, meet quality/productivity benchmarks, and prepare performance reports using Excel and PowerPoint.

Perform accurate CPT and ICD-10-CM coding, analyze and resolve denied claims via outbound provider calls, document outcomes, follow up to maximize reimbursement, meet client quality/productivity KPIs, and prepare performance reports using Excel and PowerPoint.

Conduct high-quality audits of outpatient surgery coding, follow SOPs and project protocols, meet quality and productivity targets, update logs daily, escalate issues, ensure HIPAA/OIG compliance, and communicate promptly with managers.

Perform high-volume outbound calls to US insurers, providers, and TPAs to resolve denied or pending claims, document interactions, correct denials, meet productivity and quality targets, and ensure HIPAA/OIG compliance while coordinating with internal teams and updating management on claim status.

Perform and complete inpatient DRG audits per SOP, meet quality and production targets, follow project protocols, escalate issues, update daily logs, consult managers for clarifications, ensure team HIPAA and OIG compliance, and maintain prompt communication and accurate records.

Review inpatient medical records to validate ICD-10-CM/PCS coding and DRG assignments per IPPS/CMS rules; perform coding quality audits, identify documentation gaps, collaborate with clinical teams, mentor coders and CDI specialists, produce audit reports, and maintain compliance and project logs.

Perform high-quality coding audits following SOPs and project protocols to meet quality and production targets. Maintain productivity and clarification logs, escalate issues, ensure HIPAA/OIG compliance, answer manager communications promptly, and support team problem-solving.

Manage US healthcare accounts receivable by calling insurers and patients to resolve claims, follow up on unpaid claims, post cash and write-offs, meet daily productivity and quality targets, escalate difficult cases, and ensure HIPAA compliance.

Review inpatient medical records to validate ICD-10-CM/PCS codes and DRG assignments per IPPS/CMS rules. Verify diagnoses, procedures, POA, and discharge disposition; identify documentation gaps and collaborate with clinical teams. Perform routine coding audits, analyze findings, prepare reports, mentor coders, deliver education to coders and CDI specialists, and ensure compliance with HIPAA/OIG and project SOPs.

Perform quality audits of outpatient surgery coding per SOPs, meet quality and productivity targets, update productivity and clarification logs, escalate issues, ensure HIPAA/OIG compliance, communicate with managers, and support auditing and denial management as needed.

Perform high-volume outbound calls to insurers, providers, and TPAs to resolve outstanding, denied, or rejected claims. Review claim details, document call interactions, coordinate with internal teams and payers to secure timely payments, and meet productivity and quality targets while ensuring HIPAA and compliance adherence.