EXL

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Clinical Validation Auditor III

AuditorAuditorFull TimeRemoteTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

3 days ago

Salary

$70K - $80K / year

Associate Degree5 yrs expEnglish

Job Description

• 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.

Job Requirements

  • Registered Nurse (RN) with an active license.
  • 5+ years of acute care experience (hospital setting preferred)
  • Experience in DRG audits or coding validation is a big plus!
  • Bonus points if you have certifications like CCS, RHIA, or RHIT
  • Knowledge of readmission reviews (PPR) is also a plus

Benefits

  • Health insurance
  • Retirement plans
  • Paid time off
  • Flexible work arrangements
  • Professional development opportunities

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