Quality Analyst – Clinical Validation Auditor, Healthcare

🔥 0 minutes ago

🇺🇸 United States – 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

• Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding • Review the accuracy and consistency of clinical DRG auditors to ensure audits are appropriately marked for findings and no findings • Mentor Clinical DRG auditors • Recommend process changes to improve quality and performance • Communicate with peers and management • Provide root cause analysis on errors • Perform other duties as assigned • Conduct all job functions and responsibilities in accordance with company Compliance, Information Security and Regulatory policies, procedures and programs • Oversee Clinical CVA auditor work and conduct random and targeted clinical CVA audit quality reviews

🎯 Requirements

• Current Registered Nurse license • 5 plus years experience working with clinical validation audits • Superior auditing and monitoring skills • Ability to mentor and instruct • Excellent decision making skills and sound judgment • Thorough understanding of medical terminology and human physiology • Strong technical knowledge and ability to learn new systems quickly • Excellent oral/presentation and written communication skills • Ability to complete tasks efficiently and resolve problems within set timelines • Strong organizational skills and attention to detail • Ability to work in a team environment and independently as needed • Demonstrated flexibility and adaptability • Must be able to work under deadlines and utilize independent decision-making skills in a wide variety of situations • High degree of accuracy in varied responsibilities • Personal computer skills • Self-motivated to complete work timely and meet deadlines • Strong interpersonal skills • A brief coding/auditing assessment may be included as part of the interview process

🏖️ Benefits

• Information on benefits and offerings available at https://www.exlservice.com/us-careers-and-benefits • Remote office opportunity • Work from home

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