Auditor III - CVA

Exl Service Private Limited,Noida; Dallas (TX); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player in analytics and digital solutions is seeking a Clinical Validation Auditor III for a fully remote role. In this position, you will leverage your clinical expertise to audit inpatient medical records, ensuring the accuracy of DRG codes and enhancing reimbursement processes. You'll utilize proprietary tools and industry standards to identify trends and support coding reviews, all while working independently in a collaborative environment. This role offers a unique opportunity to contribute to healthcare improvements while enjoying the flexibility of remote work. If you are passionate about clinical auditing and thrive in a results-oriented setting, this position is perfect for you.

Benefits

Paid Time Off

Bonuses

Health Benefits

Flexible Work Hours

Qualifications

• 5+ years of acute care nursing experience required.
• Preference for candidates with CCS, RHIA, or RHIT coding credentials.

Responsibilities

• Conduct clinical reviews to verify DRG assignment accuracy.
• Document audit results using ICD 10 CM/PCS coding rules.

Skills

Clinical Knowledge

Auditing Skills

Attention to Detail

Problem Solving

Time Management

Communication Skills

Analytical Skills

Education

Registered Nurse

Associate's or Bachelor's degree

Tools

3M Encoder

Webstrat

Excel

Word

OneNote

Job description

Company Overview and Culture

EXL (NASDAQ: EXLS) is a global analytics and digital solutions company that partners with clients to improve business outcomes and unlock growth. Bringing together deep domain expertise with robust data, powerful analytics, cloud, and AI, we create agile, scalable solutions and execute complex operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media, and retail, among others. Focused on creating value from data for driving faster decision-making and transforming operating models, EXL was founded on the core values of innovation, collaboration, excellence, integrity and respect. Headquartered in New York, our team is over 40,000 strong, with more than 50 offices spanning six continents.

EXL is hiring a CVA Auditor III. This is a remote, work from home opportunity.

Summary:

In this fully remote position as a Clinical Validation Auditor you will apply your expert clinical knowledge in the auditing of inpatient medical records to validate or revise the provider's billed DRG code. You will utilize industry and EXL proprietary tools in the DRG assignment process, and will write professional communications documenting audit findings and supporting rationales. You will also apply your extensive clinical and industry knowledge to identify audit trends and identify referrals for DRG coding review.

Responsibilities:

• Conduct MS-DRG and/or APR-DRG clinical reviews to verify the accuracy of the DRG assignment and reimbursement.
• Apply clinical guidelines to a variety of claim scenarios and effectively utilize industry and proprietary tools to maximize overpayment identifications.
• Document audit results in a clear, concise, and effective manner using clinical guidelines and ICD 10 CM/PCS coding rules and guidelines.
• Utilize proprietary workflow systems and encoder tools (e.g., 3M, 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.

Qualifications:

• Registered Nurse, Associate's or Bachelor's degree
• 5+ years of acute care nursing experience with preference given to candidates with prior clinical or coding validation audit experience.
• Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
• Prefer candidate with prior readmission (PPR) auditing experience.
• Preference given to candidates with CCS, RHIA, or RHIT coding credentials.

Knowledge, Skills, Behaviors:

• Extensive knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments.
• Experience with DRG encoder tools (3M, Webstrat).
• Works independently in a remote environment and delivers exceptional results during EXL core business hours.
• Possesses excellent time management and work prioritization skills.
• Takes ownership of problem solving.
• Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
• Proficient in Excel, Word, and OneNote with general computer literacy.
• Passionate about DRG Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration.

EEO/Minorities/Females/Vets/Disabilities

To view our total rewards offered click here -> us-careers-and-benefits

Base Salary Range Disclaimer: The base salary range represents the low and high end of the EXL base salary range for this position. Actual salaries will vary depending on factors including but not limited to: location and experience. The base salary range listed is just one component of EXL's total compensation package for employees. Other rewards may include bonuses, as well as a Paid Time Off policy, and many region specific benefits.

Please also note that the data shared through the job application will be stored and processed by EXL in accordance with the EXL Privacy Policy.