Clinical Validation Auditor (CVA) - Quality Analyst

EXL; United States; On-site; USD 60,000 - 95,000; Full time

Job summary

EXL Health is seeking a Clinical Validation Auditor (CVA) Quality Analyst to oversee CVA audits and mentor auditors in a remote capacity. The role emphasizes accuracy, clinical judgment, and adherence to regulatory policies.

The position includes a coding/auditing assessment during interviews and a salary range of $60,000 to $95,000 plus bonus, reflecting national hiring scales. Final offers depend on experience and location.

Qualifications

• Current Registered Nurse license.
• 5+ years of experience in clinical validation audits.

Responsibilities

• Apply clinical judgment for CVA audits to ensure accuracy of inpatient DRG coding.
• Review accuracy and consistency of clinical CVA auditing to ensure proper findings or none.
• Mentor Clinical CVA 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.
• Adhere to Compliance, Information Security and Regulatory policies.

Skills

Auditing

Mentoring

Decision making

Medical terminology

Attention to detail

Teamwork

Time management

Education

RN license

Job description

EXL Health, is seeking an experienced Clinical Validation Auditor (CVA) Quality Analyst.

This is a remote office opportunity. The Quality Analyst IV 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 $60,000 to $95,000 plus bonus

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

The posted range is the hiring range for this role — a subset of the broader range available to employees over time — and reflects base salary across our national hiring scale. 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.

The top of the range is reserved for candidates who notably exceed the requirements; the lower end applies to those with less experience or fewer preferred qualifications. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.

Responsibilities

• Apply clinical judgment for CVA audits to ensure accuracy of inpatient DRG coding
• Responsible for reviewing the accuracy and consistency of clinical CVA auditing auditors to ensure audits are appropriately marked for findings and no findings
• Mentor Clinical CVA 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 plus years 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. Must be able to 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