Quality Analyst - Clinical Validation Audit

EXL•United States,

35d•$85,000 - $100,000•Remote

About The Position

The Quality Analyst oversees work performed by Clinical auditors to ensure EXL’s standard of accuracy is met. The role conducts quality reviews of random and targeted clinical audits and applies expert clinical knowledge to audit inpatient medical records and confirm appropriate validation of providers’ billed DRG codes. The position is 100% remote within the United States, with up to 10% annual travel for team meetings and limited client onsite engagements. A brief coding/auditing assessment may be included in the interview process. The posted base salary range is $85,000–$100,000; final offers depend on factors including skills and experience, internal pay equity, work location, market conditions, and the role’s scope and responsibilities.

Requirements

Registered Nurse credential and an associate’s or bachelor’s degree.
At least 5 years of acute care nursing experience.
Superior auditing and monitoring skills.
Ability to mentor.
Extensive knowledge and understanding of clinical criteria documentation requirements used to substantiate code assignments.
Experience with DRG encoder tools such as Solventum/3M, TruBridge, or Webstrat.
Ability to work independently in a remote environment and deliver results during EXL core business hours.
Strong time management and work prioritization skills.
Problem-solving ownership.
Excellent written and verbal communication skills, strong analytical skills, and attention to detail.
Proficiency in Excel, Word, and OneNote, with general computer literacy.
Interest in DRG auditing and working in a team-oriented, collaborative environment.

Nice To Haves

Prior clinical or coding validation audit experience.
Prior DRG retrospective overpayment identification auditing experience.
Prior readmission (PPR) auditing experience.
CCS, RHIA, or RHIT coding credentials.

Responsibilities

Apply clinical judgment to DRG audits to ensure the accuracy of inpatient DRG coding.
Review the accuracy and consistency of clinical DRG auditors’ work and ensure audits are appropriately marked as findings or no findings.
Mentor Clinical DRG auditors.
Use clinical and industry knowledge to identify audit trends and referrals for DRG coding review.
Provide root cause analysis on errors.
Use industry and EXL proprietary tools in the DRG assignment process.
Write professional communications documenting audit findings and supporting rationales.
Recommend process changes to improve quality and performance.
Communicate with peers and management.
Perform other duties as assigned.
Conduct job functions and responsibilities in accordance with company compliance, information security, and regulatory policies, procedures, and programs.