Clinical Validation Auditor (CVA) Auditor III

EXL•United States,

15h•$70,000 - $85,000•Remote

About The Position

Join EXL as a Clinical Validation Auditor and help ensure medical claims are coded accurately and fairly. This is a fully remote position where you’ll use your clinical judgment to review medical records, validate billed DRG codes, and help identify overpayments. The role involves reviewing inpatient medical records to verify DRG code accuracy based on documentation, applying clinical and coding knowledge to identify inaccuracies and potential overpayments, and documenting findings professionally. The position requires working independently to meet productivity and quality goals, and staying updated with clinical guidelines, DRG rules, and industry trends. EXL offers the flexibility of remote work, a culture of support, and the opportunity to grow in the healthcare analytics field.

Requirements

Registered Nurse (RN) with an active license.
5+ years of acute care experience (hospital setting preferred).
Knowledge of readmission reviews (PPR) is also a plus.
Comfortable using tools like Excel, Word, and OneNote.

Nice To Haves

Experience in DRG audits or coding validation is a big plus!
Certifications like CCS, RHIA, or RHIT.
Love digging into the details and solving problems.
Know how to explain clinical decisions clearly and professionally.
Can manage your time well and stay focused working remotely.
Enjoy working as part of a supportive, high-performing team.

Responsibilities

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 to support your decisions.
Work independently while meeting productivity and quality goals.
Stay up to date with clinical guidelines, DRG rules, and industry trends.