Quality Analyst IV – 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 precision of inpatient DRG coding.

• Assess the accuracy and consistency of clinical DRG auditors' work and ensure that audits are correctly marked for findings and non-findings.

• Provide mentorship to Clinical DRG auditors.

• Suggest process improvements to enhance quality and performance.

• Engage in communication with peers and management.

• Conduct root cause analysis for identified errors.

• Execute additional duties as assigned.

• Carry out responsibilities in line with company Compliance, Information Security, and Regulatory policies, procedures, and programs.

⛳️ Requirements

• A current 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 a quick aptitude for learning new systems.

• Excellent oral/presentation and written communication skills.

• Efficiency in completing tasks and resolving issues within established timelines.

• Strong organizational skills and meticulous attention to detail.

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

• Proven flexibility and adaptability.

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

• High level of accuracy across various responsibilities.

• Proficiency in personal computer skills is required.

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

• Strong interpersonal skills are essential.

🏝️ Benefits

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