Clinical QA Analyst – DRG Auditing Career at EXL

EXL; United States; Remoto; USD 60.000 - 99.000; Tempo pieno

Vantaggi offerti da questo lavoro

Remote work

Descrizione del lavoro

EXL is seeking a Senior Clinical QA Analyst – DRG Auditing for a remote US-based role. You will supervise CVA audits, mentor auditors, and apply clinical judgment to ensure inpatient DRG accuracy. Strong DRG expertise and RN licensure are required.

The role offers remote work, exposure to analytics-driven healthcare operations, and potential career growth within EXL's healthcare segment. Compensation is market-competitive with room to negotiate.

Competenze

• Active RN license with 5+ years in clinical validation audits.
• Experience auditing DRG/CVA in healthcare revenue cycle.
• Ability to mentor auditors and lead quality reviews.

Mansioni

• Apply clinical judgment for DRG audits to ensure inpatient coding accuracy.
• Review audits for findings/non-findings and ensure consistency.
• Mentor CVA auditors and drive quality improvements.
• Provide root-cause analysis and communicate with management.
• Support interview process with a brief coding/auditing assessment.

Conoscenze

RN license

CVA audits

Mentoring

Formazione

Registered Nurse (RN) license

Descrizione del lavoro

Clinical QA Analyst – DRG Auditing Career at EXL — Remote

This is a senior-level clinical quality role requiring an active RN license plus 5+ years of CVA (Clinical Validation Audit) experience — a niche but high-demand specialization in healthcare revenue cycle management.

Compensation: The $60,100–$98,700 range is somewhat below market for experienced RN-level clinical auditors, where senior roles at large health systems or payers often reach $95K–$120K. The wide range suggests room to negotiate based on experience, especially for candidates with strong DRG expertise.

Skills You'll Develop:

• Clinical documentation improvement (CDI) and DRG auditing at scale
• Quality oversight and auditor mentoring — a path toward management
• Root cause analysis and process improvement in healthcare operations
• Experience with a large analytics-driven BPO, adding enterprise-level exposure

Career Path Signals: This role sits at the intersection of clinical expertise and data/analytics operations — a growing space as AI and automation reshape healthcare coding. EXL's scale (54,000+ employees, NASDAQ-listed) offers stability and potential internal mobility into leadership or analytics roles.

Green Flags: Remote work, established company with strong healthcare client base, mentorship responsibility that signals career advancement potential.

Red Flags: Compensation may be below market for seasoned auditors; limited details on PTO, advancement criteria, or team structure. The broad "other duties as assigned" language warrants clarification during interviews.

This is a remote office opportunity. The Quality Analyst oversees work performed by the Clinical CVA auditors to ensure that EXL's standard of accuracy is met. The analyst undertakes a quality review of random and targeted clinical CVA audits.

A brief coding/auditing assessment may be included as part of the interview process.

Estimated salary range is $60,100 to $98,700.

• Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding
• Review the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findings
• Mentor Clinical DRG auditors
• Recommend process changes to improve quality and performance
• Communicate with peers and management
• Provide root cause analysis on errors
• Perform other duties as assigned
• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security, and Regulatory policies, procedures, and programs

Qualifications

• Current Registered Nurse license
• 5+ years of experience working with clinical validation audits

Knowledge and Skills:

• Superior auditing and monitoring skills
• Ability to mentor and instruct
• Excellent decision-making skills and sound judgment
• Thorough understanding of medical terminology and human physiology
• Strong technical knowledge and ability to learn new systems quickly
• Excellent oral/presentation and written communication skills
• Ability to complete tasks efficiently and resolve problems within set timelines
• Strong organizational skills and attention to detail
• Ability to work in a team environment and independently as needed
• Demonstrated flexibility and adaptability
• Must be able to work under deadlines and utilize independent decision-making skills in a wide variety of situations
• Requires a high degree of accuracy in the performance of varied responsibilities
• Personal computer skills required; must be self-motivated to complete work in a timely manner to meet deadlines
• Strong interpersonal skills required

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes, and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world's leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com .

EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL's Human Resources team, as well as our hiring managers.

Is this Quality Analyst position fully remote? Yes, the job posting explicitly states this is a remote office opportunity. However, candidates must be US-based, as the role is restricted to the United States. What is the salary range for this role at EXL? The estimated salary range is $60,100 to $98,700 annually. Final offers depend on the candidate's skills and experience, internal pay equity, work location, and market conditions. Do I need an active nursing license for this position? Yes, a current Registered Nurse (RN) license is a required qualification, along with 5 or more years of experience working with clinical validation audits. Will there be a skills assessment during the interview process? Yes, a brief coding/auditing assessment may be included as part of the interview process to evaluate your clinical auditing knowledge. What kind of experience is needed for the Clinical CVA Quality Analyst role? Candidates need at least 5 years of experience with clinical validation audits, strong DRG coding knowledge, an active RN license, and demonstrated skills in auditing, mentoring, and clinical documentation.

Remote work & career advice that actually works.