Clinical Validation Auditor (CVA) Auditor III

EXL•Pittsburgh, PA

1d•Remote

About The Position

EXL is seeking a nurse with a strong understanding of inpatient care to review medical records and help ensure that medical claims are coded accurately and fairly. This fully remote, U.S.-based role uses clinical judgment to validate billed Diagnosis-Related Group (DRG) codes against medical documentation and identify potential overpayments. The position may include 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. The posted base salary range is $60,100–$98,700, with final offers depending on factors including skills, experience, internal pay equity, work location, market conditions, and role scope.

Requirements

Registered Nurse (RN) with an active 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).
Experience with tools such as 3M or Webstrat; training may be provided.

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 each review.
Use industry tools such as 3M or Webstrat to support review decisions.
Work independently while meeting productivity and quality goals.
Stay up to date with clinical guidelines, DRG rules, and industry trends.