Clinical Validation Auditor III

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

📋 Description

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

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

• Record findings in a clear and professional manner, detailing the reasoning behind review decisions.

• Employ industry tools like 3M or Webstrat to assist in audit conclusions.

• Operate independently while achieving productivity and quality targets.

• Keep abreast of clinical guidelines, DRG regulations, and industry developments.

⛳️ Requirements

• Registered Nurse (RN) with a valid license.

• Over 5 years of acute care experience, ideally in a hospital environment.

• Experience in DRG audits or coding validation is advantageous.

• Certification as CCS, RHIA, or RHIT is a plus.

• Familiarity with readmission reviews (PPR) is beneficial.

• Capability to articulate clinical decisions in a clear and professional manner.

• Strong time management skills and ability to concentrate while working remotely.

• Proficient in Excel, Word, and OneNote.

• Comfortable functioning independently as well as part of a high-performing team.

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

🏝️ Benefits

• Fully remote work / work from home.

• Supportive, collaborative culture.

• Opportunity to advance in the rapidly changing field of healthcare analytics.

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

• Potential compensation exceeding the advertised range for higher-cost areas such as California, New York, and New Jersey.