Clinical Validation Audit Quality Manager

ExlService Holdings, Inc.; United States; Remote; USD 75,000 - 123,000; Full time

Job summary

ExlService Holdings, Inc. is seeking a CVA Quality Manager to lead planning, coordination, and execution of Clinical Validation Audit quality review activities.

You will oversee quality teams, ensure adherence to CMS regulations and payer requirements, and drive continuous improvement across programs. The role supports inventory management, QA aging, risk assessment, and day-to-day performance, with remote, U.S.-based responsibilities and limited travel for meetings.

Qualifications

• Strong leadership and analytical skills.
• Expert clinical knowledge including inpatient medical record review.
• Experience with CMS regulations and payer requirements.
• Proven ability to govern quality programs across audits.
• Familiarity with audit tools and data analysis.

Responsibilities

• Lead planning, coordination, and execution of Clinical Validation Audit quality review activities.
• Oversee inventory, QA aging, risks, and day-to-day quality performance.
• Manage CVA quality analysts and validate audit accuracy and outcomes.
• Collaborate cross-functionally to support program success.
• Oversee additional quality specialties as needed.

Skills

Leadership

Analytical

Clinical knowledge

CMS regulations

Payer requirements

Quality governance

Inpatient medical record review

Tools

Audit tools

Job description

The CVA Quality Manager leads the planning, coordination, and execution of Clinical Validation Audit quality review activities, ensuring quality teams meet productivity goals, inventory expectations, client SLAs, and internal quality standards. This role oversees inventory, QA aging, risks, and day-to-day quality performance, while collaborating cross-functionally to support program success.

The role directly manages a team of CVA quality analysts responsible for reviewing auditor-completed Clinical Validation Audit work, validating audit accuracy, and ensuring accurate clinical validation outcomes. This leader may also oversee additional quality specialties within clinical or coding audit programs. The ideal candidate demonstrates strong leadership and analytical skills, along with expert clinical knowledge, experience with inpatient medical record review, clinical criteria documentation requirements, audit tools, and a solid understanding of CMS regulations, payer requirements, and quality governance.

Salary Range: $75,100 – $123,400, based on experience, skills, and qualifications.

Location: 100% Remote, U.S.-based.

Travel: Limited travel may be required for team meetings.

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

For more information on benefits and what we offer, please visit us at https://www.exlservice.com/us-careers-and-benefits