Quality Analyst IV – Healthcare

EXL

. Perform random, targeted, follow-up, and focused quality reviews of completed IRF audits .

Posted 9/18/2026full-timeRemote • United StatesMid-LevelSenior💰 $70,000 - $110,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in IRF audit processes, including documentation validation, coding logic, and reimbursement methodologies. Proficient in providing constructive feedback and conducting quality reviews to ensure compliance with CMS guidance and internal standards.

Highest-signal resume keywords

IRF Audit ExperienceICD-10-CM/PCS KnowledgeQuality Review and ValidationRoot Cause AnalysisCoding Credentials (CCS, RHIA, RHIT, CIC, CPC)

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Inpatient Facility CodingAudit ValidationDocumentation ReviewReimbursement ReviewQuality ScoringMedical Record AbstractionAudit Scoring ExpectationsPayer Reimbursement MethodologiesIRF-PAI CompletionDocumentation Validation

Soft Skills

Analytical SkillsProblem-SolvingAttention to DetailWritten CommunicationVerbal Communication

Tools & Technologies

ExcelWordOutlookOneNoteAudit Workflow ToolsEncoder ToolsMedical Record Review Platforms

Certifications & Qualifications

CCSRHIARHITCICCPC

Industry Keywords

IRF-PAICMS GuidanceHIPAA ComplianceRehabilitation FacilityPayment Integrity

About the role

Key responsibilities & impact

Perform random, targeted, follow-up, and focused quality reviews of completed IRF audits
Validate audit findings, no-findings, documentation support, coding logic, reimbursement impact, and audit rationale
Follow approved sampling methodology and quality review procedures
Apply quality scoring criteria to evaluate audit accuracy, documentation quality, client requirements, and EXL standards
Confirm IRF audit determinations are supported by the IRF-PAI, UB-04/final bill, discharge summary, complete IRF medical record, therapy and physician documentation, nursing notes, MAR, pre-admission screening, plan of care, interdisciplinary team documentation, CMS guidance, payer requirements, and internal procedures
Validate IRF-PAI completion and supporting documentation, including impairment group, etiologic diagnosis, date of onset, comorbid conditions, complication/comorbidity reporting, treatment received, and reimbursement support
Review audit documentation for clarity, completeness, grammar, evidence-based support, and quality expectations
Identify documentation, coding, and reimbursement discrepancies affecting IRF payment
Provide professional feedback and coaching to IRF Auditors, including corrections and improvement opportunities
Identify audit trends, recurring errors, documentation gaps, inconsistent audit logic, and process or training needs
Perform root cause analysis and recommend corrective actions
Support calibration discussions, quality monitoring, score reviews, SOP updates, and training opportunities
Write communications documenting quality outcomes, findings, rationale, trends, coaching recommendations, and next steps
Maintain quality review results and reporting for performance monitoring, trend analysis, leadership review, and quality improvement
Communicate quality results, risks, trends, and recommendations to peers and management
Stay current with IRF reimbursement updates, CMS guidance, IRF-PAI manual updates, ICD-10-CM/PCS updates, payer policies, and internal procedures
Perform responsibilities in accordance with company compliance, information security, HIPAA, and regulatory policies

Requirements

What you’ll need

Minimum High School Diploma required
Associate’s or bachelor’s degree in Health Information Management, healthcare administration, nursing, rehabilitation services, or a related healthcare field preferred
CCS, RHIA, RHIT, CIC, CPC, or comparable coding credential preferred; multiple coding credentials strongly preferred
5+ years of inpatient facility coding, auditing, payment integrity, reimbursement review, quality review, audit validation, or related healthcare experience preferred
Strong IRF audit, IRF coding, IRF reimbursement, IRF-PAI, or rehabilitation facility documentation review experience strongly preferred
Strong understanding of ICD-10-CM/PCS, inpatient facility claim review, medical record abstraction, documentation validation, payer reimbursement methodologies, audit scoring expectations, and the relationship between documentation, coded data, IRF-PAI elements, and reimbursement outcomes
Experience identifying quality errors, missed opportunities, documentation gaps, inconsistent audit application, and trends in complex inpatient or IRF audit work
Experience reviewing lengthy medical records and tying documentation to reimbursement impact, treatment during the IRF stay, payer/client requirements, and audit findings
Ability to provide constructive, specific, and actionable feedback to auditors
Ability to evaluate auditor work objectively and distinguish IRF-PAI documentation requirements from traditional acute-care DRG coding logic
Strong analytical, problem-solving, root cause analysis, and critical-thinking skills with excellent attention to detail
Excellent written and verbal communication skills
Ability to work independently in a remote environment while maintaining quality, productivity, confidentiality, and timely completion
Proficient in Excel, Word, Outlook, OneNote, and general computer applications
Experience with audit workflow tools, coding references, encoder tools, and medical record review platforms preferred
Commitment to teamwork, calibration, continuous learning, process improvement, and accurate audit outcomes
HIPAA compliance

Benefits

Comp & perks

Up to 10% annual travel for team meetings and limited client onsite engagements
Benefits information provided via EXL US Careers and Benefits
Remote work from home