Quality Analyst – Clinical Validation Auditor, Healthcare

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

📋 Description

• Utilize clinical judgment for DRG audits to ensure the accuracy of inpatient DRG coding.

• Examine the precision and consistency of clinical DRG auditors to guarantee that audits are correctly marked for findings and no findings.

• Guide and mentor Clinical DRG auditors.

• Suggest process improvements to enhance quality and efficiency.

• Engage in communication with peers and management.

• Provide root cause analysis for identified errors.

• Carry out additional duties as assigned.

• Execute all job functions and responsibilities in alignment with company Compliance, Information Security, and Regulatory policies, procedures, and programs.

• Supervise Clinical CVA auditor work and perform random and targeted clinical CVA audit quality reviews.

⛳️ Requirements

• Valid Registered Nurse license.

• Over 5 years of experience in clinical validation audits.

• Exceptional auditing and monitoring abilities.

• Capability to mentor and instruct others.

• Strong decision-making skills and sound judgment.

• Comprehensive understanding of medical terminology and human physiology.

• Robust technical knowledge with the ability to rapidly learn new systems.

• Outstanding oral/presentation and written communication skills.

• Capacity to accomplish tasks efficiently and resolve issues within established timelines.

• Strong organizational skills with a keen attention to detail.

• Ability to work both collaboratively in a team setting and independently as required.

• Proven flexibility and adaptability.

• Must manage deadlines effectively and utilize independent decision-making skills across various situations.

• High level of accuracy in diverse responsibilities.

• Proficient personal computer skills.

• Self-motivated to complete work promptly and meet deadlines.

• Strong interpersonal skills.

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

🏝️ Benefits

• Information on benefits and offerings available at https://www.exlservice.com/us-careers-and-benefits.

• Remote office opportunity.

• Work from home.