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Quality Analyst IV – Clinical Validation Auditor, Healthcare

AuditorAuditorFull TimeRemoteSeniorTeam 10,001+H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

29 days ago

Salary

$70K - $93K / year

Seniority

Senior

Professional Certificate5 yrs expEnglish

Job Description

• Oversee work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met • Undertake a quality review of random and targeted clinical DRG audits • Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding • Responsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and 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 all job functions and responsibilities in accordance with all company Compliance, Information Security and Regulatory policies, procedures and programs

Job Requirements

  • Current Registered Nurse license
  • Minimum 5 years 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
  • Must be able to work under deadlines. Must be able to utilize independent decision-making skills in a wide variety of situations
  • Requires a high degree of accuracy in the performance of varied responsibilities.
  • Personal computer skills required. Must be self-motivated to complete work in a timely manner to meet deadlines
  • Strong interpersonal skills required

Benefits

  • For more information on benefits and what we offer please visit us at https://www.exlservice.com/us-careers-and-benefits

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