Clinical Validation Auditor III

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

📋 Description

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

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

• Record findings in a clear and professional manner, articulating the reasoning behind reviews.

• Leverage industry tools like 3M or Webstrat to aid in audit decisions.

• Operate independently while achieving productivity and quality objectives.

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

⛳️ Requirements

• Active Registered Nurse (RN) license required.

• More than 5 years of acute care experience, preferably in a hospital environment.

• Experience in DRG audits or coding validation is advantageous.

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

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

• Capability to communicate clinical decisions clearly and professionally.

• Strong time management skills and focus while working remotely.

• Proficiency in Excel, Word, and OneNote.

• Ability to work independently while achieving productivity and quality targets.

• Bachelor's Degree is required.

🏝️ Benefits

• Fully remote work.

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

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

• Supportive and high-performing team culture.

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