Clinical Validation Auditor – Auditor III

🔥 12 minutes ago

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EXL

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

📦 Logistics

💰 $2M Venture Round on 2015-01

Healthcare • Insurance • Logistics

EXL is a business consulting and services firm that focuses on leveraging data to enhance business operations and decision-making. With a strong emphasis on collaboration and adaptability, EXL partners with organizations to address their unique needs and culture while integrating data science and technology solutions. The company's areas of expertise include operations management, decision analytics, digital transformation, and various industries such as healthcare, finance, and insurance. EXL's mission is to help clients drive business evolution and maintain competitive advantage through tailored solutions and effective use of data.

📋 Description

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

🎯 Requirements

• Registered Nurse (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! • Bonus points if you have certifications like CCS, RHIA, or RHIT • Knowledge of readmission reviews (PPR) is also a plus

🏖️ Benefits

• Flexible remote work • A culture of support • Opportunity to grow in healthcare analytics