Senior Remote DRG Clinical Validation Auditor

EXL

United States

Remote

USD 60,000 - 99,000

Full time

3 days ago

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Job summary

EXL is seeking a Quality Analyst to oversee and perform clinical CVA audits ensuring accuracy in inpatient DRG coding. The role involves reviewing audits for consistency, coaching clinical DRG auditors, and driving quality improvements across processes.

The position requires a current RN license and 5+ years in clinical validation audits, with strong auditing, communication, and problem-solving skills. This remote opportunity offers exposure to a broad healthcare analytics environment and

Qualifications

Current Registered Nurse license.
5+ years experience with clinical validation audits.
Superior auditing and monitoring skills.
Excellent decision making and judgment.
Strong communication skills and ability to mentor.
High accuracy and attention to detail.

Responsibilities

Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding.
Review the accuracy and consistency of clinical DRG auditing audits to ensure findings are correctly marked 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 in accordance with company Compliance, Information Security and Regulatory policies.