Quality Analyst IV - Clinical Validation Auditor (CVA), Healthcare

EXL Health, is seeking an experienced Clinical Validation Auditor (CVA) / Diagnosis-Related Group (DRG) Quality Analyst.  

This is a remote office opportunity. The Quality Analyst IV oversees work performed by the Clinical DRG auditors to ensure that EXL’s standard of accuracy is met. The analyst undertakes 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

• Current Registered Nurse license 

• Minimum 5 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 

Salary Range is: $70k - $93k

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

EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.

EXL never requires or asks for fees/payments or credit card or bank details during any phase of the recruitment or hiring process and has not authorized any agencies or partners to collect any fee or payment from prospective candidates. EXL will only extend a job offer after a candidate has gone through a formal interview process with members of EXL’s Human Resources team, as well as our hiring managers.