Clinical Validation Auditor III

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $60.1k - $98.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔎 Auditor

👻 Ghost score 2%

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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 and clearly explain the rationale behind 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, preferably in a hospital setting • 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 remain focused while working remotely • Comfortable using Excel, Word, and OneNote • Ability to work independently while meeting productivity and quality goals • 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 • Supportive, high-performing team culture • Continuous improvement and professional growth opportunities • Training on industry tools such as 3M or Webstrat if needed

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