• Responsible for managing Nurse auditors and other contract auditors to ensure smooth operations of daily activities and ensuring that audit productivity and quality standards are met.
• Perform best practice reviews and identify areas for improvement. Performs beyond one role among Clinical auditor, QC and dispute. Training and guiding reviewers for enhancement
• Verifying the patient information, other insurance information, Validating the paid information and contract to identify the overpayments. Responsibilities

Qualifications:
• Bachelor’s degree in nursing
• Active State Nursing certification is Mandatory
• Minimum 4 years of clinical/hospital experience is mandatory Communication:
• Strong written (documentation) and oral communication skills

Experience:
• Minimum 4 years of clinical experience.
• Auditing experience (Optional)

Working Hours
• 40 hours per week as Full-time employee
• Shift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)
• Weekends: Off Telecommuter/Internet requirements, if applicable:
• High Speed internet connection at home, must be broadband
• Must understand and adhere with telecommuter policy Qualifications Computer Literacy Microsoft Office Quality Auditing experiencce Familiarity with basic medical terminology and concepts used in care management.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.




• Should have a good understanding of US healthcare system and management.
• Perform audit based on clinical knowledge while reviewing the medical record
• Demonstrate learning skills during process training and in advancing career
• Perform quality assurance reviews to assess comprehension of training efforts.
• Ensure to process the audit with accountability
• Ensure to view all documented system information as well as any additional records/data presented to support a determination or recommendation.
• Condenses all clinical information into a clear and accurate clinical picture while taking a final decision.
• Pro-actively and consistently engage in enhancing process/work knowledge and delivery the work with high values.
• Actively update process knowledge and follow the new change in process.
• Be ready to analyze the errors and if required approach to quality team for further clarification.
• Maintain a professional work environment.
• Follow every aspect of SOP without fail.
• Complete received Audits with Quality.
• Achieve expected Quality and production target.
• Follow project-related protocols and instructions.
• Update all the logs like productivity, Clarification log, and any other logs applicable daily.
• Complete alignment with Manager /TL in terms of program delivery.
• Responding to all emails promptly without fail.
• Ensure compliance of the entire team.

📌 Senior Executive (Chennai)
🏢 EXL
📍 Chennai