Senior Executive - Clinical Auditor

EXL Talent Acquisition Team; Chennai; On-site; INR 400,000 - 520,000; Full time

Job summary

EXL Talent Acquisition Team is seeking a detail-oriented Medical Claims Auditor in Chennai to review and audit patient records for accuracy and completeness. You will identify variances between clinical documentation and billed services, validate diagnoses, procedures, and level of care in line with industry standards.

You will ensure CMS guidelines, payer policies and regulatory requirements are followed during audits, suggest corrective actions, and collaborate with coding, billing and

Responsibilities

• Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation.
• Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors.
• Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards.
• Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes.
• Conduct best practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities.
• Provide structured findings and audit reports with clear recommendations for corrective action and process improvement.
• Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions.
• Monitor trends in audit results and identify recurring issues requiring targeted education or intervention.
• Support quality assurance initiatives by maintaining audit accuracy benchmarks and meeting productivity standards.
• Participate in continuous improvement activities, including updates on CMS regulations, clinical guidelines, and payer policy changes.

Job description

• Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation.
• Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors.
• Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards.
• Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes.
• Conduct best practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities.
• Provide structured findings and audit reports with clear recommendations for corrective action and process improvement.
• Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions.
• Monitor trends in audit results and identify recurring issues requiring targeted education or intervention.
• Support quality assurance initiatives by maintaining audit accuracy benchmarks and meeting productivity standards.
• Participate in continuous improvement activities, including updates on CMS regulations, clinical guidelines, and payer policy changes.