Clinical Validation Auditor III

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

📋 Description

• Examine inpatient medical records to ensure DRG codes are substantiated by documentation.

• Utilize clinical and coding expertise to detect inaccuracies and potential overpayments.

• Record findings in clear, professional language, detailing the reasoning behind each review.

• Employ industry tools such as 3M or Webstrat to facilitate 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 (hospital setting preferred).

• Experience in DRG audits or coding validation is advantageous.

• 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 Excel, Word, and OneNote.

• Ability to work autonomously while meeting productivity and quality benchmarks.

• A brief coding/auditing assessment may be part of the interview process.

🏝️ Benefits

• Fully remote work environment.

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

• Opportunity for growth in the rapidly changing field of healthcare analytics.

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