Clinical Validation Auditor (CVA) Auditor III

EXL•United States,

9d•$60,100 - $98,700•Remote

About The Position

EXL is hiring a Clinical Validation Auditor to review inpatient medical records and assess whether billed Diagnosis-Related Group (DRG) codes are supported by the documentation. The role applies clinical and coding knowledge to identify inaccuracies and potential overpayments, and requires documenting review findings and the rationale clearly and professionally. This is a fully remote, U.S.-based position with up to 10% annual travel for team meetings and limited client onsite engagements. The auditor works independently while meeting productivity and quality goals, and stays current with clinical guidelines, DRG rules, and industry trends. 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 remain 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).

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 in clear, professional language and explain the rationale for review decisions.
Use 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.