Remote Readmission Quality Analyst & Audit Coach

EXL; Oregon; Hybrid; USD 60,000 - 99,000; Full time

Job summary

EXL is hiring a Clinical Readmission Review Quality Analyst to oversee audit accuracy, documentation quality, and clinical rationale across remote reads. The role includes coaching auditors, analyzing trends, and recommending process improvements while ensuring compliance with HIPAA and program requirements.

The position offers a salary range of $60,100–$98,700 with up to 10% travel, remote US-based, and benefits as part of EXL’s offerings.

Qualifications

• Active, unrestricted RN license in the United States is required.
• 5+ years of acute care nursing, utilization review, clinical auditing, readmission review, quality review, or related healthcare experience preferred.
• Prior readmission, quality control, secondary review or peer review experience is a plus.
• Knowledge of potentially preventable readmission concepts, readmission drivers, discharge planning, transitions of care, and medical necessity preferred.
• Strong written and verbal communication, analytical skills, and attention to detail.

Responsibilities

• Apply clinical judgment to ensure accuracy and consistency of audits.
• Perform quality reviews of random and targeted samples to validate findings and supporting documentation.
• Follow approved sampling methodology for quality reviews.
• Apply quality scoring criteria to evaluate accuracy and documentation.
• Confirm readmission determinations are supported by the medical record and client requirements.
• Review audit documentation for clarity, completeness, and evidence-based support.
• Provide feedback and coaching to auditors based on quality outcomes.

Skills

Clinical Readmission Review

Quality Control Review

Audit Sampling

Medical Record Review

Clinical Judgment

Quality Feedback

Calibration

Trend Identification

Written Communication

HIPAA Compliance

Education

RN license (US)

Associate's or Bachelor's degree

Tools

Excel

Word

Outlook

OneNote

Job description

EXL is hiring a Clinical Readmission Review Quality Analyst to oversee audit accuracy, documentation quality, and clinical rationale across remote reads. The role includes coaching auditors, analyzing trends, and recommending process improvements while ensuring compliance with HIPAA and program requirements.

The position offers a salary range of $60,100–$98,700 with up to 10% travel, remote US-based, and benefits as part of EXL’s offerings.