Clinical Validation Auditor (CVA)

EXL; United States; Remote; USD 60,000 - 99,000; Full time

Job summary

EXL is seeking a qualified Clinical Validation Auditor to review inpatient records, validate DRG codes, and help prevent improper payments in a fully remote role based in the U.S.

As a Registered Nurse with 5+ years in acute care, you’ll apply clinical and coding knowledge using tools like 3M or Webstrat, document findings clearly, and stay current with DRG rules while meeting productivity and quality targets.

Qualifications

• RN license and active status.
• 5+ years in acute care hospital setting.
• Experience with DRG audits or coding validation.
• Certifications CCS, RHIA, or RHIT are a plus.
• Knowledge of readmission reviews (PPR) is also a plus.

Responsibilities

• Review inpatient medical records to verify DRG codes align with documentation.
• Apply clinical and coding knowledge to spot inaccuracies and identify potential overpayments.
• Document findings in clear, professional language with rationale.
• Use industry tools like 3M or Webstrat; training provided if needed.
• Work independently while meeting productivity and quality goals.
• Stay up to date with clinical guidelines, DRG rules, and industry trends.

Skills

RN licensed

Acute care experience

DRG audits

Coding validation

CCS

RHIA

RHIT

Readmission reviews

Tools

Excel

Word

OneNote

Job description

Are you a nurse with a strong understanding of inpatient care and a passion for getting the details right? Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded accurately and fairly. This is a fully remote position where you’ll use your clinical judgment to review medical records, validate billed DRG codes, and help identify overpayments.

Salary Range: $60,100 – $98,700 (based on experience, skills, and qualifications)

Location: 100% Remote (U.S.-based)

Up to 10% annual travel (for team meetings and limited client onsite engagements.)

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

Responsibilities

What You’ll Be Doing:

• Review inpatient medical records to verify that the DRG (Diagnosis-Related Group) code makes sense based on the documentation.
• Apply clinical and coding knowledge to spot inaccuracies and identify potential overpayments.
• Document your findings in clear, professional language that explains the rationale behind your review.
• Use industry tools like 3M or Webstrat (don’t worry—we’ll train you if needed!) to support your decisions.
• Work independently while meeting productivity and quality goals.
• Stay up to date with clinical guidelines, DRG rules, and industry trends.

Qualifications

What We’re Looking For:

• Registered Nurse (RN) with an active license.
• 5+ years of acute care experience (hospital setting preferred)
• Experience in DRG audits or coding validation is a big plus!
• Bonus points if you have certifications like CCS, RHIA, or RHIT
• Knowledge of readmission reviews (PPR) is also a plus

You’ll Be a Great Fit If You:

• Love digging into the details and solving problems
• Know how to explain clinical decisions clearly and professionally
• Can manage your time well and stay focused working remotely
• Are comfortable using tools like Excel, Word, and OneNote
• Enjoy working as part of a supportive, high-performing team

Why Work at EXL?

At EXL, you’ll join a team that values collaboration, clinical accuracy, and continuous improvement. We offer the flexibility of remote work, a culture of support, and the opportunity to grow in the fast-evolving world of healthcare analytics.

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.