Quality Analyst - Clinical Validation Auditor (CVA), Healthcare

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

Job summary

EXL is seeking a remote Quality Analyst to supervise the Clinical CVA auditing process, ensuring accuracy and consistency across audits. The role includes mentoring auditors, applying clinical judgment to DRG reviews, and driving quality improvements.

The position requires RN licensure and 5+ years of clinical validation audit experience, with strong communication and problem-solving skills to operate under deadlines and regulatory guidelines.

Qualifications

• Current Registered Nurse license is required.
• 5+ years of experience with clinical validation audits.

Responsibilities

• 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.
• Ensure compliance with company policies and regulatory requirements.

Skills

Auditing & monitoring

Mentoring

Clinical validation audits

Decision making

Communication

Medical terminology

Self-motivation

Teamwork

Education

Registered Nurse license

Tools

DRG coding systems

Job description

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
• Responsible for reviewing 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 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
• 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.

EXL is the indispensable partner for leading businesses in data-led industries such as insurance, banking and financial services, healthcare, retail and logistics. We bring a unique combination of data, advanced analytics, digital technology and industry expertise to help our clients turn data into insights, streamline operations, improve customer experience, and transform their business. Our partnerships with clients are built on a foundation of collaboration – and we’ve been chosen as a partner by nine of the top ten leading US insurance companies, nine of the top 20 global banks, and six of the top ten US health care payers. We function as one team to make your goals our goals, whether that’s unlocking the value of generative AI or embedding analytics into workflows that reduce risk or power your growth. Clients choose EXL as their transformation partner for many reasons. Our geographic diversity make talent all over the world instantly accessible. Digital accelerators enable unmatched speed-to-value, letting you realize results fast. It’s our people that truly set us apart, though, including the 1,500 data scientists we have dedicated to our generative AI practice. And our more than twenty years of experience in delivering business services, garnering stellar client references, and maintaining a solid balance sheet are reassuring to our C-suite clients. Find out for yourself why clients, employees, and analysts think we’re some of the best in the business. Contact us to see how we can help you achieve your goals.

Tags

Full-Stack Programming Problem Solving and Communication Skills

Details

Who may apply USA Only As the board states it — check the description for country or time-zone limits.