Senior Executive - Clinical Auditor

Y-Axis; Chennai District; Remote; INR 450,000 - 750,000; Full time

Job summary

EXL Talent Acquisition Team is seeking a Senior Executive - Clinical Auditor in India to review and audit medical claims, ensuring documentation accuracy and CMS compliance. The role involves identifying billing discrepancies, supporting corrective actions, and collaborating with provider teams.

Key responsibilities include examining records for accuracy, following payer policies, and contributing to QA and process improvements within a remote-capable setup.

Qualifications

• Auditors must review medical claims against patient records for accuracy and documentation completeness.
• Identify discrepancies between clinical docs and billed services to highlight errors.

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.

Skills

Clinical Auditing

Medical Claims Review

CMS Guidelines

Clinical Documentation

Medical Coding

Revenue Leakage Identification

Quality Assurance

Patient Medical Records Analysis

Regulatory Compliance

Corrective Action Planning

Job description

Senior Executive - Clinical Auditor at EXL Talent Acquisition Team

Full Time

Start Date

Immediate

Expiry Date

11 Oct, 26

Posted On

13 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Clinical Auditing, Medical Claims Review, CMS Guidelines, Clinical Documentation, Medical Coding, Revenue Leakage Identification, Quality Assurance, Patient Medical Records Analysis, Regulatory Compliance, Corrective Action Planning

Business Consulting and Services

Description

• Review and audit medical claims against patient medical records to ensureaccuracy 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, andlevel of care in accordance with industry standards.
• Ensure compliance with CMS guidelines, payer policies, and regulatoryrequirements during claim review processes.
• Conduct best practice audits to identify documentation gaps, codinginaccuracies, and revenue leakage opportunities.
• Provide structured findings and audit reports with clear recommendations forcorrective action and process improvement.
• Collaborate with coding, billing, and provider teams to resolve auditfindings and support accurate claim submissions.
• Monitor trends in audit results and identify recurring issues requiringtargeted education or intervention.
• Support quality assurance initiatives by maintaining audit accuracybenchmarks and meeting productivity standards.
• Participate in continuous improvement activities, including updates on CMSregulations, clinical guidelines, and payer policy changes.

Responsibilities

The role involves auditing medical claims against patient records to ensure documentation accuracy and compliance with CMS guidelines. The candidate will identify billing errors and collaborate with provider teams to implement corrective actions and process improvements.