Clinical Validation Auditor (CVA) Auditor III

EXL; Oregon; Hybride; USD 60 000 - 99 000; Plein temps

Résumé du poste

EXL is seeking a Clinical Validation Auditor to review inpatient records, ensuring DRG codes align with documentation and to identify potential overpayments. This fully remote, U.S.-based role leverages clinical judgment to validate billing accuracy.

You'll use tools like 3M or Webstrat, document findings clearly, and work independently while meeting productivity and quality goals. A RN with 5+ years of acute care experience and DRG audit familiarity is ideal.

Qualifications

• 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.
• Certifications such as CCS, RHIA, or RHIT are a plus.
• Knowledge of readmission reviews (PPR) is a plus.

Responsabilités

• Review inpatient medical records to verify that the DRG code makes sense based on the documentation.
• Apply clinical and coding knowledge to spot inaccuracies and identify potential overpayments.
• Document findings in clear, professional language explaining the rationale behind the review.
• Use industry tools like 3M or Webstrat to support decisions.
• Work independently while meeting productivity and quality goals.
• Stay up to date with clinical guidelines, DRG rules, and industry trends.

Formation

Registered Nurse (RN) with an active license

Outils

3M

Webstrat

Description du poste

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

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.