Quality Analyst IV – Clinical Validation Auditor, Healthcare

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

📋 Description

• Supervises the work conducted by Clinical DRG auditors to ensure compliance with EXL’s accuracy standards.

• Performs quality assessments of both random and targeted clinical DRG audits.

• Utilizes clinical judgment in DRG audits to guarantee the accuracy of inpatient DRG coding.

• Responsible for assessing the accuracy and consistency of clinical DRG auditors to ensure audits are correctly categorized as having findings or no findings.

• Provides mentorship to Clinical DRG auditors.

• Proposes process improvements to enhance quality and performance.

• Engages in communication with peers and management.

• Conducts root cause analysis on identified errors.

• Executes additional duties as assigned.

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

⛳️ Requirements

• Valid Registered Nurse license.

• Over 5 years of experience in clinical validation audits.

• Exceptional auditing and monitoring capabilities.

• Proficiency in mentoring and instructing others.

• Strong decision-making abilities and sound judgment.

• Comprehensive knowledge of medical terminology and human physiology.

• Advanced technical skills and the capacity to quickly learn new systems.

• Excellent oral, presentation, and written communication abilities.

• Efficient task completion skills and problem-solving capabilities within established timelines.

• Strong organizational skills and meticulous attention to detail.

• Ability to work collaboratively in a team setting as well as independently when necessary.

• Proven flexibility and adaptability in various situations.

• Capacity to work under deadlines and utilize independent decision-making skills in diverse circumstances.

• Requires a high level of accuracy in performing various responsibilities.

• Competence in personal computer usage is essential. Must be self-motivated to complete tasks promptly to meet deadlines.

• Strong interpersonal skills are required.

🏝️ Benefits

• For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits.