Quality Analyst – Clinical Validation Audit

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

📋 Description

• Utilize clinical judgment in DRG audits to ensure the precise coding of inpatient DRGs.

• Assess the accuracy and consistency of clinical DRG auditors' work.

• Ensure that audits are correctly marked to indicate findings and non-findings.

• Provide mentorship to Clinical DRG auditors.

• Identify trends in audits and make referrals for DRG coding reviews.

• Conduct root cause analyses on identified errors.

• Leverage industry standards and EXL proprietary tools during the DRG assignment process.

• Compose professional communications that document audit findings and the rationale behind them.

• Suggest process improvements to enhance quality and performance.

• Engage in communication with peers and management.

• Carry out additional responsibilities as assigned.

• Adhere to company policies regarding Compliance, Information Security, and Regulatory standards.

⛳️ Requirements

• Must hold a Registered Nurse designation, along with an Associate's or Bachelor's degree.

• A minimum of 5 years of experience in acute care nursing is required.

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

• Experience in identifying overpayments through DRG retrospective audits is preferred.

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

• Preferred coding credentials include CCS, RHIA, or RHIT.

• Exceptional auditing and monitoring skills are necessary.

• Capability to mentor others is essential.

• Strong understanding of clinical criteria documentation requirements for substantiating code assignments.

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

• Ability to work autonomously in a remote setting during EXL core business hours.

• Strong time management skills and the ability to prioritize tasks effectively.

• Problem-solving skills are a must.

• Excellent written and verbal communication abilities are required.

• Strong analytical skills and a keen attention to detail.

• Proficient in Excel, Word, and OneNote.

• General computer literacy is expected.

• A passion for DRG auditing and collaboration is essential.

🏝️ Benefits

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

• A dynamic, fast-paced, and innovative work environment.

• Opportunity to collaborate with highly experienced, world-class Healthcare consultants.

• Learning opportunities across various client businesses.

• Access to guidance and coaching through a mentoring program.

• Each junior-level employee will be assigned a senior-level professional advisor.

• Opportunities for personal growth and professional development.