Clinical Validation Auditor III

🕒 2 days ago

🇺🇸 United States – Remote

💵 $70k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 4%

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.

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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 DRG codes against documentation • Apply clinical and coding knowledge to identify inaccuracies and potential overpayments • Document findings in clear, professional language and explain review rationale • Use industry tools such as 3M or Webstrat to support 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 • Comfortable using Excel, Word, and OneNote • Ability to work independently while meeting productivity and quality goals

🏖️ 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 • Supportive, high-performing team environment • Training on industry tools such as 3M or Webstrat if needed • Benefits information available at https://www.exlservice.com/us-careers-and-benefits