Clinical Validation Audit Trainer

This is a fully remote position, open to applicants in United States.

📋 Description

• Provide captivating learning experiences for both new-hire and experienced CVA coders.

• Leverage clinical and DRG knowledge for training focused on inpatient DRG validation and coding accuracy.

• Assess clinical DRG audit results for accuracy and consistency, guiding training, coaching, and remediation efforts.

• Guide and mentor Clinical DRG Auditors through specialized education, feedback, and knowledge reinforcement.

• Examine audit trends to uncover learning gaps or recommend additional DRG coding education or review.

• Conduct root-cause analyses on audit discrepancies and convert findings into effective training and performance support.

• Utilize industry standards and proprietary EXL tools to enhance DRG validation training and education.

• Create training communications and materials that document audit scenarios, findings, and clinical justifications.

• Suggest training and process enhancements to improve audit quality and performance results.

• Relay training needs, trends, and progress updates to colleagues, auditors, and management.

• Adhere to company compliance, information security, and regulatory standards.

• Undertake additional duties as assigned.

⛳️ Requirements

• Must possess a Registered Nurse certification, with an associate or bachelor's degree.

• Minimum of 5 years of experience in acute care nursing.

• At least 2 years of experience in facilitating training delivery.

• Previous experience in clinical or coding validation audits is preferred.

• Experience in DRG retrospective overpayment identification audits is preferred.

• Prior experience in readmission (PPR) auditing is preferred.

• Preferred certifications include CCS, RHIA, or RHIT in coding.

• Proven skills in training facilitation, including instructor-led, virtual, and blended training for adult learners.

• Capability to articulate complex coding guidelines and audit concepts in a clear and practical manner.

• Strong communication and facilitation skills are essential.

• Analytical skills are required to identify knowledge gaps, recurring mistakes, and training opportunities from audit trends.

• In-depth understanding of clinical criteria documentation requirements necessary for substantiating code assignments.

• Ability to collaborate effectively with Quality, Audit, and Subject Matter Experts (SMEs) in a cross-functional remote setting.

• Excellent organizational, time management, and work prioritization skills.

• Familiarity with DRG encoder tools such as Solventum/3M, TruBridge, and Webstrat.

• Capability to work independently in a remote setting during EXL core business hours.

• Exceptional written and verbal communication, analytical skills, and meticulous attention to detail.

• Proficient in Excel, Word, and OneNote, along with general computer literacy.

• Comfortable using virtual meeting platforms, Learning Management Systems (LMS), and MS Teams.

• A strong passion for DRG auditing, teamwork, excellence, and collaboration.

🏝️ Benefits

• Mentoring program offering guidance/coaching, with junior-level employees paired with senior-level professional advisors.

• Opportunities to collaborate closely with seasoned healthcare consultants.

• Professional growth and development opportunities available.

• Up to 10% annual travel for team meetings and some client onsite engagements.