Clinical Validation Auditor, Auditor III

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

📋 Description

• Assess inpatient medical records to ensure that DRG codes are substantiated by the documentation.

• Utilize clinical and coding expertise to pinpoint inaccuracies and identify potential overpayments.

• Record findings in clear, professional language, providing explanations for the reviews conducted.

• Employ industry tools such as 3M or Webstrat to back audit decisions.

• Operate independently while achieving productivity and quality targets.

• Keep updated with clinical guidelines, DRG regulations, and industry developments.

⛳️ Requirements

• Active Registered Nurse (RN) license.

• Over 5 years of experience in acute care (preferably in a hospital environment).

• Experience with DRG audits or coding validation is highly advantageous.

• Relevant certifications such as CCS, RHIA, or RHIT are beneficial.

• Familiarity with readmission reviews (PPR) is a plus.

• Capability to articulate clinical decisions clearly and professionally.

• Strong time management skills and the ability to maintain focus while working remotely.

• Proficiency in using Excel, Word, and OneNote.

• Bachelor’s Degree required.

🏝️ Benefits

• Work fully remotely.

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

• Collaborative, high-achieving team environment.

• Opportunities for advancement in healthcare analytics.

• Training on 3M or Webstrat provided if necessary.

• Benefits information can be found at https://www.exlservice.com/us-careers-and-benefits.