Clinical Validation Auditor, Auditor III

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $60.1k - $98.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 2%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 DRG codes are supported by documentation • Apply clinical and coding knowledge to identify inaccuracies and potential overpayments • Document findings in clear, professional language, explaining the rationale for reviews • Use industry tools such as 3M or Webstrat to support audit decisions • Work independently while meeting productivity and quality goals • Stay current 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 • Certifications such as CCS, RHIA, or RHIT are a plus • Knowledge of readmission reviews (PPR) is a plus • Ability to explain clinical decisions clearly and professionally • Ability to manage time and stay focused while working remotely • Comfortable using Excel, Word, and OneNote • Bachelor's Degree

🏖️ Benefits

• Fully remote work • Up to 10% annual travel for team meetings and limited client onsite engagements • Supportive, high-performing team environment • Opportunity to grow in healthcare analytics • Training on 3M or Webstrat if needed • Benefits information available at https://www.exlservice.com/us-careers-and-benefits