Quality Analyst – Clinical Validation Audit

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $85k - $100k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 3%

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

• Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding • Review the accuracy and consistency of clinical DRG auditors and ensure audits are appropriately marked for findings or no findings • Mentor Clinical DRG auditors • Use clinical and industry knowledge to identify audit trends and referrals for DRG coding review • Provide root cause analysis on errors • Use industry and EXL proprietary tools in the DRG assignment process • Write professional communications documenting audit findings and supporting rationales • Recommend process changes to improve quality and performance • Communicate with peers and management • Perform other duties as assigned • Follow company Compliance, Information Security, and Regulatory policies, procedures, and programs

🎯 Requirements

• Registered Nurse, Associate's or Bachelor's degree • 5+ years of acute care nursing experience • Prior clinical or coding validation audit experience preferred • Prior DRG retrospective overpayment identification auditing experience preferred • Prior readmission (PPR) auditing experience preferred • CCS, RHIA, or RHIT coding credentials preferred • Superior auditing and monitoring skills • Ability to mentor • Extensive knowledge and understanding of clinical criteria documentation requirements used to substantiate code assignments • Experience with DRG encoder tools (Solventum/3M, TruBridge, Webstrat) • Ability to work independently in a remote environment during EXL core business hours • Excellent time management and work prioritization skills • Problem-solving ability • Excellent written and verbal communication skills • Strong analytical skills and attention to detail • Proficiency in Excel, Word, and OneNote with general computer literacy • Passion for DRG auditing and teamwork, excellence, and collaboration

🏖️ Benefits

• Up to 10% annual travel for team meetings and limited client onsite engagements • Exciting, fast paced, and innovative work environment • Opportunity to work closely with highly experienced, world class Healthcare consultants • Opportunities to learn many aspects of clients' businesses • Mentoring program with guidance/coaching from senior-level professionals • Opportunities for personal and professional growth • Further growth and development opportunities within EXL Health and beyond