EXL

Analyzes business data and runs outsourced operations

Quality Analyst - Clinical Validation Auditor, Healthcare

Clinical Support & Patient AdministrationConfirmed live in the last 24 hours

Full-timeRemote in USA$60.1k - $98.7k

About the Job

Requirements

A current Registered Nurse license is required.
At least five years of experience working with clinical validation audits is required.
Superior auditing and monitoring skills are required.
The role requires the ability to mentor and instruct.
A thorough understanding of medical terminology and human physiology is required.
Strong technical knowledge and the ability to learn new systems quickly are required.
Excellent oral, presentation, and written communication skills are required.
The role requires the ability to complete tasks efficiently and resolve problems within set timelines.
Strong organizational skills and attention to detail are required.
The role requires the ability to work in a team environment and independently as needed.
Flexibility and adaptability are required.
The role requires working under deadlines and using independent decision-making skills in a wide variety of situations.
A high degree of accuracy in performing varied responsibilities is required.
Personal computer skills and self-motivation to complete work in a timely manner and meet deadlines are required.
Strong interpersonal skills are required.

Responsibilities

Oversee work performed by Clinical CVA auditors to ensure EXL's standard of accuracy is met.
Review random and targeted clinical CVA audits for quality.
Apply clinical judgment for DRG audits to ensure inpatient DRG coding is accurate.
Review 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 company compliance, information security, and regulatory policies, procedures, and programs.

This is a remote office opportunity. The Quality Analyst oversees work performed by the Clinical CVA auditors to ensure that EXL’s standard of accuracy is met. The analyst undertakes a quality review of random and targeted clinical CVA audits.

A brief coding/auditing assessment may be included as part of the interview process

Estimated salary range is $60,100 to $98,700

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

Current Registered Nurse license

5 plus years experience working with clinical validation audits

Knowledge and Skills:

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

The posted base salary range is the hiring base salary range for this role. Final offers are based on several factors, including: the candidate's skills and experience, internal pay equity, work location, market conditions for the role, and the specific scope and responsibilities of the position.

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

About the Company

EXL

Analyzes business data and runs outsourced operations

EXL analyzes business data and runs outsourced operations for insurers, healthcare payers, banks, retailers, and other large organizations. Its teams combine industry expertise with data engineering and AI to handle tasks such as claims processing, payment reviews, customer service, and finance within existing technology environments. The company also builds software, including LifePRO, which manages insurance policies, and EXLdata.ai, which connects fragmented data for use in AI systems. Clients pay for consulting projects, ongoing managed services, and software delivered through the cloud. EXL was founded in 1999 and is headquartered in New York City.

Company size: 10,001+
Company stage: IPO
Headquarters: New York City, New York
Founded: 1999

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