Remote RN Clinical Validation Auditor – DRG & Claims

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

Job summary

EXL is seeking a Clinical Validation Auditor to review inpatient records, ensuring DRG codes align with documentation and to identify potential overpayments. This fully remote, U.S.-based role leverages clinical judgment to validate billing accuracy.

You'll use tools like 3M or Webstrat, document findings clearly, and work independently while meeting productivity and quality goals. A RN with 5+ years of acute care experience and DRG audit familiarity is ideal.

Qualifications

• RN with an active license.
• 5+ years of acute care experience (hospital setting preferred).
• Experience in DRG audits or coding validation is a big plus.
• Certifications such as CCS, RHIA, or RHIT are a plus.
• Knowledge of readmission reviews (PPR) is a plus.

Responsibilities

• Review inpatient medical records to verify that the DRG code makes sense based on the documentation.
• Apply clinical and coding knowledge to spot inaccuracies and identify potential overpayments.
• Document findings in clear, professional language explaining the rationale behind the review.
• Use industry tools like 3M or Webstrat to support decisions.
• Work independently while meeting productivity and quality goals.
• Stay up to date with clinical guidelines, DRG rules, and industry trends.

Education

Registered Nurse (RN) with an active license

Tools

3M

Webstrat

Job description

EXL is seeking a Clinical Validation Auditor to review inpatient records, ensuring DRG codes align with documentation and to identify potential overpayments. This fully remote, U.S.-based role leverages clinical judgment to validate billing accuracy.

You'll use tools like 3M or Webstrat, document findings clearly, and work independently while meeting productivity and quality goals. A RN with 5+ years of acute care experience and DRG audit familiarity is ideal.