Clinical Validation Auditor III
EXL
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $70,000 - $80,000 per year
Job Level
Mid-LevelSenior
About the role
- Review inpatient medical records to verify that the DRG (Diagnosis-Related Group) code makes sense based on the documentation.
- Apply clinical and coding knowledge to spot inaccuracies and identify potential overpayments.
- Document your findings in clear, professional language that explains the rationale behind your review.
- Use industry tools like 3M or Webstrat (don’t worry—we’ll train you if needed!) to support your decisions.
- Work independently while meeting productivity and quality goals.
- Stay up to date 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!
- Bonus points if you have certifications like CCS, RHIA, or RHIT
- Knowledge of readmission reviews (PPR) is also a plus
Benefits
- Flexibility of remote work
- Culture of support
- Opportunity to grow in the fast-evolving world of healthcare analytics
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
DRG codingclinical knowledgecoding validationreadmission reviews
Soft skills
independent workdocumentationcommunication
Certifications
Registered Nurse (RN)CCSRHIARHIT