EXL

Analyzes business data and runs outsourced operations

Senior Executive - Clinical Auditor

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours

Full-timeChennai, Tamil Nadu, IndiaNo salary listedIn-person

About the Job

Requirements

A bachelor's degree in nursing is required.
Active state nursing certification is mandatory.
A minimum of 3 years of clinical or hospital experience is required.
Candidates should have strong written documentation and oral communication skills.
Candidates should be familiar with basic medical terminology and concepts used in care management.
Candidates should understand the U.S. healthcare system and its management.
Candidates must be able to participate effectively in a multidisciplinary team with internal and external participants.
Candidates must have a high-speed broadband internet connection at home and adhere to the telecommuter policy.
Candidates should demonstrate learning ability during process training and career development.
Candidates should maintain a professional work environment and follow every aspect of the standard operating procedure.
Candidates should promptly respond to emails and update applicable productivity and clarification logs daily.

Responsibilities

Review and audit medical claims against patient medical records to ensure documentation accuracy and completeness.
Identify discrepancies between clinical documentation and billed services, including variances and potential billing errors.
Conduct detailed clinical reviews to validate diagnoses, procedures, and levels of care in accordance with industry standards.
Ensure compliance with Centers for Medicare & Medicaid Services guidelines, payer policies, and regulatory requirements during claim reviews.
Conduct best-practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities.
Provide structured findings and audit reports with clear recommendations for corrective action and process improvement.
Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions.
Monitor audit-result trends and identify recurring issues requiring targeted education or intervention.
Support quality-assurance initiatives by maintaining audit-accuracy benchmarks and meeting productivity standards.
Participate in continuous-improvement activities, including updates on Centers for Medicare & Medicaid Services regulations, clinical guidelines, and payer-policy changes.
Perform audits using clinical knowledge while reviewing medical records.
Perform quality-assurance reviews to assess comprehension of training efforts.
Process audits with accountability, reviewing all documented system information and any additional records or data provided to support a determination or recommendation.
Condense clinical information into a clear and precise clinical picture when making a final decision.
Analyze errors and consult the quality team for clarification when needed.
Complete assigned audits to the required quality standard and meet expected quality and production targets.
Follow project-related protocols and instructions and keep applicable logs updated daily.
Coordinate with the manager or team lead regarding program delivery.
Ensure compliance across the team.

Desired Qualifications

Auditing experience is optional.

Review and audit medical claims against patient medical records to ensure accuracy and completeness of documentation.
Identify discrepancies between clinical documentation and billed services, highlighting variances and potential billing errors.
Perform detailed clinical reviews to validate diagnosis, procedures, and level of care in accordance with industry standards.
Ensure compliance with CMS guidelines, payer policies, and regulatory requirements during claim review processes.
Conduct best practice audits to identify documentation gaps, coding inaccuracies, and revenue leakage opportunities.
Provide structured findings and audit reports with clear recommendations for corrective action and process improvement.
Collaborate with coding, billing, and provider teams to resolve audit findings and support accurate claim submissions.
Monitor trends in audit results and identify recurring issues requiring targeted education or intervention.
Support quality assurance initiatives by maintaining audit accuracy benchmarks and meeting productivity standards.
Participate in continuous improvement activities, including updates on CMS regulations, clinical guidelines, and payer policy changes.

Qualifications:
Bachelor’s degree in nursing
Active State Nursing certification is Mandatory
Minimum 3 years of clinical/hospital experience is mandatory
Experience:
Minimum 3 years of clinical experience.
Auditing experience (Optional)
Communication:
Strong written (documentation) and oral communication skills
Working Hours:
40 hours per week as Full-time employee
Shift time: 08:00 AM TO 05:00 PM IST (It might be changed based on project requirements)
Weekends: Off
Telecommuter/Internet requirements, if applicable:
High Speed internet connection at home, must be broadband
Must understand and adhere with telecommuter policy

Familiarity with basic medical terminology and concepts used in care management.
Ability to effectively participate in a multi-disciplinary team including internal and external participants.
Should have a good understanding of US healthcare system and management.
Perform audit based on clinical knowledge while reviewing the medical record
Demonstrate learning skills during process training and in advancing career
Perform quality assurance reviews to assess comprehension of training efforts.
Ensure to process the audit with accountability
Ensure to view all documented system information as well as any additional records/data presented to support a determination or recommendation.
Condenses all clinical information into a clear and precise clinical picture while taking a final decision.
Pro-actively and consistently engage in enhancing process/work knowledge and delivery the work with high values.
Actively update process knowledge and follow the new change in process.
Be ready to analyze the errors and if required approach to quality team for further clarification.
Maintain a professional work environment.
Follow every aspect of SOP without fail.
Complete received Audits with Quality.
Achieve expected Quality and production target.
Follow project-related protocols and instructions.
Update all the logs like productivity, Clarification log, and any other logs applicable daily.
Complete alignment with Manager /TL in terms of program delivery.
Responding to all emails promptly without fail.
Ensure compliance of the entire team.

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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