Quality Analyst – Clinical Validation Audit

🕒 2 dias atrás

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $85.000 - $100.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

👻 Score fantasma 2%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

Candidatar-se

Encontrar Vagas Remotas Similares

Configurar Alerta de Email para Novas Vagas

📊 Verifique sua pontuação de currículo para esta vaga

Melhore suas chances de conseguir uma entrevista verificando sua pontuação de currículo antes de se candidatar.

Enviar Currículo

EXL

SiteLinkedInTodas as Vagas

10.000+ funcionários

🏥 Saúde

🛡️ Seguros

📦 Logística

💰 $2.000.000 Venture Round em 2015-01

Healthcare • Insurance • Logistics

Escolher um parceiro digital vai além das capacidades — trata-se de colaboração e caráter.

Descrição

• Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding • Review the accuracy and consistency of clinical DRG auditors • Ensure audits are appropriately marked for findings and no findings • Mentor Clinical DRG auditors • Identify audit trends and referrals for DRG coding review • Provide root cause analysis on errors • Utilize industry and EXL proprietary tools in the DRG assignment process • Write professional communications documenting audit findings and supporting rationales • Recommend process changes to improve quality and performance • Communicate with peers and management • Perform other duties as assigned • Follow company Compliance, Information Security, and Regulatory policies, procedures, and programs

🎯 Requisitos

• Registered Nurse, Associate's or Bachelor's degree • 5+ years of acute care nursing experience • Prior clinical or coding validation audit experience preferred • Prior DRG retrospective overpayment identification auditing experience preferred • Prior readmission (PPR) auditing experience preferred • CCS, RHIA, or RHIT coding credentials preferred • Superior auditing and monitoring skills • Ability to mentor • Extensive knowledge of clinical criteria documentation requirements used to substantiate code assignments • Experience with DRG encoder tools (Solventum/3M, TruBridge, Webstrat) • Ability to work independently in a remote environment during EXL core business hours • Excellent time management and work prioritization skills • Problem-solving ability • Excellent written and verbal communication skills • Strong analytical skills and attention to detail • Proficiency in Excel, Word, and OneNote • General computer literacy • Passion for DRG auditing and teamwork

🏖️ Benefícios

• Up to 10% annual travel for team meetings and limited client onsite engagements • Exciting, fast paced, and innovative environment • Opportunity to work closely with highly experienced, world class Healthcare consultants • Learning opportunities across clients’ businesses • Guidance/coaching through a mentoring program • Senior-level professional advisor assigned to every junior-level employee • Opportunities for growth and development