Quality Analyst – Clinical Validation Audit

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

📋 Description

• Utilize clinical judgment during DRG audits to guarantee the precision of inpatient DRG coding.

• Assess the accuracy and consistency of clinical DRG auditors, ensuring audits are appropriately categorized as having findings or no findings.

• Provide mentorship to Clinical DRG auditors.

• Leverage clinical and industry expertise to pinpoint audit trends and referrals for DRG coding assessment.

• Conduct root cause analysis on identified errors.

• Employ industry standards and EXL proprietary tools within 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.

• Execute additional responsibilities as assigned.

• Adhere to company Compliance, Information Security, and Regulatory policies, procedures, and programs.

⛳️ Requirements

• Registered Nurse with an Associate's or Bachelor's degree.

• Minimum of 5 years acute care nursing experience.

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

• Prior experience in DRG retrospective overpayment identification auditing is preferred.

• Experience in readmission (PPR) auditing is preferred.

• CCS, RHIA, or RHIT coding credentials are preferred.

• Exceptional auditing and monitoring skills.

• Capability to provide mentorship.

• Comprehensive knowledge of clinical criteria documentation requirements essential for supporting code assignments.

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

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

• Strong time management and work prioritization abilities.

• Problem-solving skills.

• Excellent verbal and written communication skills.

• Strong analytical abilities and attention to detail.

• Proficiency in Excel, Word, and OneNote, along with general computer literacy.

• Enthusiasm for DRG auditing, teamwork, excellence, and collaboration.

🏝️ Benefits

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

• An exciting, fast-paced, and innovative work environment.

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

• Opportunities to learn various aspects of clients' businesses.

• A mentoring program that offers guidance and coaching from senior-level professionals.

• Opportunities for personal and professional development.

• Further growth and advancement opportunities within EXL Health and beyond.