Clinical Validation Auditor III

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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 the documentation • Apply clinical and coding knowledge to identify inaccuracies and potential overpayments • Document findings clearly and professionally, including the rationale for review decisions • 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, preferably in a hospital setting • Experience in DRG audits or coding validation is a plus • CCS, RHIA, or RHIT certification is a plus • Knowledge of readmission reviews (PPR) is a plus • Ability to explain clinical decisions clearly and professionally • Ability to manage time effectively and stay focused while working remotely • Proficiency with Excel, Word, and OneNote • Comfortable working independently and as part of a high-performing team • A brief coding/auditing assessment may be included in the interview process

🏖️ Benefits

• Fully remote work / work from home • Supportive, collaborative culture • Opportunity to grow in the fast-evolving world of healthcare analytics • Benefits information provided at https://www.exlservice.com/us-careers-and-benefits • Potential compensation above the posted range for higher-cost zones such as California, New York, and New Jersey