Remote Quality Analyst - Clinical Validation & DRG Auditing

EXL; Oregon; Hybrid; USD 85,000 - 110,000; Full time

Job summary

EXL, a leading data analytics and digital operations partner, seeks a Quality Analyst for a remote office to oversee clinical CVA audits. You will review random and targeted DRG audits, apply clinical judgment, mentor auditors, and drive process improvements to ensure accuracy and compliance with EXL standards.

Requirements include a current Registered Nurse license and 5+ years of experience in clinical validation audits, plus strong auditing, communication, and problem-solving skills to meet

Qualifications

• Current Registered Nurse license.
• 5+ years experience working 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.
• Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs.

Skills

Auditing

Mentoring

Decision making

Medical terminology

Tech savvy

Communication

Attention to detail

Education

Registered Nurse license

Job description

EXL, a leading data analytics and digital operations partner, seeks a Quality Analyst for a remote office to oversee clinical CVA audits. You will review random and targeted DRG audits, apply clinical judgment, mentor auditors, and drive process improvements to ensure accuracy and compliance with EXL standards.

Requirements include a current Registered Nurse license and 5+ years of experience in clinical validation audits, plus strong auditing, communication, and problem-solving skills to meet