• Conduct Home Health reviews to verify the accuracy of the billed services based on CMS guidelines. • Apply CMS guidelines during medical record review to ensure services provided are supported. In addition, utilize industry and proprietary tools to maximize overpayment identifications. • Document audit results in a clear, concise, and effective manner using CMS Home Health, Oasis and ICD-10 CM Guidelines. • Utilize proprietary workflow systems and encoder tools (e.g., Decision Health, Webstrat, etc.) efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly. • Meet or exceed EXL established program productivity and quality goals, including uphold rate for appeals. • Demonstrate knowledge of and compliance with changes and updates to clinical guidelines, reimbursement trends, and client processes and requirements. • Comply with all EXL policies and procedures including HIPAA and other state and federal regulations.