Temp. Part-time: Skilled Nursing Facility (SNF) / Patient-Driven Payment Model (PDPM)

This is a remote position where the SNF/PDPM Quality Analyst is responsible for conducting quality reviews of completed audits, ensuring compliance with CMS regulations, internal policies client requirements, and audit methodologies. The role evaluates the accuracy, consistency, and defensibility of audit determinations, identifies trends and process improvement opportunities, and contributes to overall quality performance and operational excellence.  

• Hourly Range: $36.00 – $47.45
• Location: 100% Remote (U.S.-based)
• Up to 10% annual travel (for team meetings and limited client onsite engagements.)

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

Responsibilities

Quality Review and Audit Oversight: Demonstrates expertise in the following:

• Perform quality reviews of completed SNF/PDPM audits to validate coding accuracy, reimbursement determinations, supporting documentation, and audit rationale

• Ensure audit findings align with CMS guidelines, RAI Manual requirements, PDPM regulations, client requirements, and departmental procedures

• Document quality review findings clearly and accurately

• Identify quality trends, recurring audit errors, and opportunities for process improvement

• Provide constructive written feedback to auditors

Performance Management: Consistently contributes to client saving/internal revenue goals

• Achieves productivity and quality goals

Team Work: Understands duties, team goals, and consistently achieves performance required

• Demonstrates awareness of goals by achieving performance requirements (self-accountability)

• Responds timely to emails and meeting requests (is in attendance as scheduled/requested)

• Actively participates in discussions and Team Meetings, providing suggestions of improvement or volunteers when needed

• Adhere to all EXL Health policies and procedures

• Report any problems in the audit or quality process to Quality Manager for resolution. 

• Identify and communicate facility and provider specific issues that impact audits.

Continuous Improvement / Education

• Maintain current knowledge of CMS regulations, PDPM reimbursement methodology, MDS 3.0 requirements, and industry best practices

• Monitor regulatory changes affecting SNF/PDPM auditing activities 

Qualifications

• Registered Nurse, Licensed Practical Nurse, or Licensed Vocational Nurse license in good standing in the state that you reside

• Minimum of 5 years’ experience with SNF clinical, MDS 3.0 completion, PDPM reimbursement methodology, quality assurance, auditing, and/or related experience 

• Advanced knowledge of MDS 3.0 coding guidelines, skilled nursing facility (SNF) levels of care, and PDPM reimbursement

• Previous experience/exposure to the billing of HIPPS codes

• Experience reviewing audit findings, conducting quality revises, or performing compliance monitoring activities

Knowledge & Skills

• Experience with: Excel, PowerPoint, Outlook, and Word

• Experience with Encoder tools such as 3M

• Experience with and expertise with Medicare Local Coverage Determinations (LCD) and National Coverage Determinations (NCD)

• Must be detail oriented

• Must have excellent verbal and written communication skills

• Must be self-directed and able to work with minimum oversight

What We Offer You:

• A fast-paced, innovative environment with a team of sharp, driven professionals
• Remote work flexibility and a chance to impact healthcare delivery nationwide
• Opportunities for growth and mentorship through our structured coaching program
• A collaborative culture where your ideas and insights are valued
• Real opportunities for advancement—your future here is what you make it!

At EXL Health, you’ll not only do meaningful work—you’ll grow your career, expand your skills, and be part of a team that values your contribution.

Ready to take your career to the next level? Apply today!

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.