Clinical Validation Auditor – Auditor III
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Job Description
Clinical Validation Auditor reviewing inpatient records and DRG codes at EXL, a healthcare analytics company. Identifying coding inaccuracies and potential overpayments through clinical judgment.
Responsibilities:
- Review inpatient medical records to verify that DRG codes are supported by documentation
- Apply clinical and coding knowledge to identify inaccuracies and potential overpayments
- Document findings in clear, professional language explaining the review rationale
- Use industry tools such as 3M or Webstrat to support review decisions
- Work independently while meeting productivity and quality goals
- Stay current with clinical guidelines, DRG rules, and industry trends
Requirements:
- Registered Nurse (RN) with an active license
- 5+ years of acute care experience (hospital setting preferred)
- Experience in DRG audits or coding validation is a big plus
- Certifications such as CCS, RHIA, or RHIT are a plus
- Knowledge of readmission reviews (PPR) is a plus
- Ability to explain clinical decisions clearly and professionally
- Ability to manage time well and stay focused working remotely
- Comfortable using Excel, Word, and OneNote
- Ability to work as part of a supportive, high-performing team
- A brief coding/auditing assessment may be included in the interview process
Benefits:
- Fully remote work
- Up to 10% annual travel for team meetings and limited client onsite engagements
- Supportive, high-performing team culture
- Opportunity to grow in the fast-evolving world of healthcare analytics
- Training on 3M or Webstrat if needed
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