Clinical Validation Auditor (CVA) Auditor III

EXL • Pittsburgh, PA

2d • $60,100 - $98,700 • Remote

About The Position

EXL is hiring a Clinical Validation Auditor to review inpatient medical records, validate billed Diagnosis-Related Group (DRG) codes, and identify potential overpayments. The role uses clinical judgment and coding knowledge to assess whether DRG codes are supported by the documentation, and requires clear, professional documentation of review findings. The position is fully remote and U.S.-based, with up to 10% annual travel for team meetings and limited client onsite engagements. A brief coding or auditing assessment may be part of the interview process.

Requirements

• Active Registered Nurse (RN) license.
• At least 5 years of acute care experience; hospital experience is preferred.
• Ability to explain clinical decisions clearly and professionally.
• Ability to manage time and stay focused while working remotely.
• Comfort using Excel, Word, and OneNote.

Nice To Haves

• Experience in DRG audits or coding validation.
• Certifications such as CCS, RHIA, or RHIT.
• Knowledge of readmission reviews (PPR).
• Enjoy working as part of a supportive, high-performing team.

Responsibilities

• Review inpatient medical records to verify that DRG codes are supported by the documentation.
• Apply clinical and coding knowledge to identify inaccuracies and potential overpayments.
• Document findings clearly and professionally, including the rationale for review decisions.
• 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.

Benefits

• Remote work flexibility.
• Supportive culture and opportunities to grow in healthcare analytics.
• Benefits information is available through EXL's careers and benefits website.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed