Quality Analyst IV – Clinical Validation Auditor, Healthcare

EXL

Quality Analyst IV at EXL Health overseeing clinical validation audits. Responsible for quality reviews and ensuring accuracy in clinical DRG auditing processes.

Posted 7/2/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $60,100 - $98,700 per yearWebsite

About the role

Key responsibilities & impact

Oversees work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met.
Undertakes a quality review of random and targeted clinical DRG audits.
Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding
Responsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findings
Mentor Clinical DRG auditors
Recommend process changes to improve quality and performance
Communicate with peers and management
Provide root cause analysis on errors
Perform other duties as assigned
Conduct all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs

Requirements

What you’ll need

Current Registered Nurse license
5 plus years experience working with clinical validation audits
Superior auditing and monitoring skills
Ability to mentor and instruct
Excellent decision making skills and sound judgment
Thorough understanding of medical terminology and human physiology
Strong technical knowledge and ability to learn new systems quickly
Excellent oral/presentation and written communication skills
Ability to complete tasks efficiently and resolve problems within set timelines
Strong organizational skills and attention to detail
Ability to work in a team environment and independently as needed
Demonstrated flexibility and adaptability
Must be able to work under deadlines. Must be able to utilize independent decision-making skills in a wide variety of situations
Requires a high degree of accuracy in the performance of varied responsibilities.
Personal computer skills required. Must be self-motivated to complete work in a timely manner to meet deadlines
Strong interpersonal skills required

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Clinical DRG AuditingInpatient DRG CodingQuality ReviewProcess ImprovementDecision MakingTechnical KnowledgeProblem ResolutionAttention to DetailCompliance PoliciesInformation Security

Soft Skills

MentoringCommunication SkillsOrganizational SkillsInterpersonal SkillsFlexibility

Certifications

Registered Nurse License