Quality Analyst IV – Clinical Validation Auditor, Healthcare

🕒 July 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

• Oversees work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met. • Undertakes a quality review of random and targeted clinical DRG audits. • Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding • Responsible for reviewing the accuracy and consistency of clinical DRG auditing 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 all company Compliance, Information Security and Regulatory policies, procedures and programs

🎯 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. Must be able to utilize independent decision-making skills in a wide variety of situations • Requires a high degree of accuracy in the performance of varied responsibilities. • Personal computer skills required. Must be self-motivated to complete work in a timely manner to meet deadlines • Strong interpersonal skills required

🏖️ Benefits

• For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits