Quality Analyst - Clinical Validation Auditor (CVA), Healthcare

EXL•United States,

10h•$60,000 - $100,000•Remote

About The Position

The Quality Analyst oversees work performed by Clinical CVA auditors to ensure EXL’s accuracy standards are met. The role reviews random and targeted clinical CVA audits and applies clinical judgment to DRG audits to support accurate inpatient DRG coding. It also evaluates the accuracy and consistency of auditors’ work, mentors Clinical DRG auditors, recommends process improvements, and performs root cause analysis on errors. The position is remote and requires compliance with company policies, procedures, and programs relating to compliance, information security, and regulatory requirements. A brief coding/auditing assessment may be included in the interview process.

Requirements

Current Registered Nurse license.
Five or more years of experience working with clinical validation audits.
Superior auditing and monitoring skills.
Ability to mentor and instruct.
Excellent decision-making skills and sound judgment.
Thorough understanding of medical terminology and human physiology.
Strong technical knowledge and ability to learn new systems quickly.
Excellent oral, presentation, and written communication skills.
Ability to complete tasks efficiently and resolve problems within set timelines.
Strong organizational skills and attention to detail.
Ability to work in a team environment and independently as needed.
Demonstrated flexibility and adaptability.
Ability to work under deadlines and use independent decision-making across a wide variety of situations.
High degree of accuracy in performing varied responsibilities.
Personal computer skills and self-motivation to complete work on time and meet deadlines.
Strong interpersonal skills.

Responsibilities

Apply clinical judgment for DRG audits to ensure accurate inpatient DRG coding.
Review the accuracy and consistency of clinical DRG auditors’ work and ensure audits are appropriately marked for findings or no findings.
Mentor Clinical DRG auditors.
Recommend process changes to improve quality and performance.
Communicate with peers and management.
Provide root cause analysis on errors.
Perform other duties as assigned.
Conduct job functions and responsibilities in accordance with company compliance, information security, and regulatory policies, procedures, and programs.