Clinical Validation Auditor III

🔥 2 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $60.1k - $98.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 2%

What it means: the chance that no one is really hiring for this job.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.

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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 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 each review • 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 plus • CCS, RHIA, or RHIT certifications 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 • Ability to work independently and meet productivity and quality goals • A brief coding/auditing assessment may be included in the interview process

🏖️ Benefits

• Fully remote work • Up to 10% annual travel for team meetings and limited client onsite engagements • Opportunity to grow in the fast-evolving world of healthcare analytics • Benefits information available at https://www.exlservice.com/us-careers-and-benefits

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