Quality Analyst IV - Clinical Validation Auditor (CVA), Healthcare

Ex; United States; Remote; USD 90,000 - 130,000; Full time

Job summary

EXL is hiring a Quality Analyst - Clinical Validation Auditor (CVA) for a remote role in healthcare. You will oversee Clinical CVA audits, applying clinical judgment to DRG accuracy and mentoring auditors across the team.

Daily responsibilities include mentoring, process improvement, and communicating findings with management to drive quality. The position requires a current RN license and 5+ years in clinical validation audits, with strong auditing, terminology knowledge, and cross-functional

Qualifications

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

Responsibilities

• Apply clinical judgment for DRG audits to ensure inpatient DRG coding accuracy.
• Review the accuracy and consistency of DRG auditing processes and findings.
• Mentor Clinical DRG auditors to uphold quality standards.
• Recommend process changes to improve quality and performance.
• Communicate with peers and management to align on goals.
• Provide root cause analysis on errors identified in audits.
• Perform other duties as assigned to meet team needs.
• Adhere to Compliance, Information Security and Regulatory policies.

Skills

APR-DRG

Attention to Consistency

Clinical Auditing

Computer Literacy

DRG Experience

Internal Communications

Interpersonal Skills

Leadership Abilities

MS-DRG

Microsoft Excel

Microsoft Word

RN Review

Education

Registered Nurse license

Tools

MS-DRG

Microsoft Excel

Microsoft Word

DRG Software (unspecified)

Job description

Quality Analyst - Clinical Validation Auditor (CVA), Healthcare

Job Info

• Job Identification 21391
• Posting Date 10/13/2026, 08:10 AM
• Job Role Training-Coding
• Experience (In Years) 3-6
• Job Location Remote

Job Description

Thisisaremoteofficeopportunity.TheQualityAnalystoverseesworkperformedbytheClinicalCVAauditorstoensurethatEXL'sstandardofaccuracyismet.TheanalystundertakesaqualityreviewofrandomandtargetedclinicalCVAaudits.

• 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.

Required Skills

• APR-DRG
• Attention To Consistency
• Clinical Auditing
• Computer Literacy
• Diagnosis-Related Group (DRG) Experience
• Internal Communications
• Interpersonal Relationship Building
• Leadership Capabilities
• MS-DRG
• Microsoft Excel
• Microsoft Word
• Registered Nurse Review

About Us

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.