Senior Clinical Validation Auditor & DRG Lead Remote

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

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