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

EXL
United States
Remote

Who this role is best for

Strong fit for experienced clinical auditors who mentor teams and apply medical judgment in a remote healthcare setting.

Best fit for

  • Candidates with a Registered Nurse license and 5+ years in clinical validation audits
    — “Current Registered Nurse license 5 plus years experience working with clinical validation audits”
  • Individuals who excel at root cause analysis and process optimization in healthcare
    — “Recommend process changes to improve quality and performance”

Things to consider

  • The role demands high accuracy and independent decision-making under deadlines
    — “Requires a high degree of accuracy in the performance of varied responsibilities”
  • Candidates must be prepared to work remotely with no indication of in-office requirements
    — “This is a remote office opportunity”

How to stand out

  • Highlight experience mentoring auditors and improving audit processes in your resume
    — “Mentor Clinical DRG auditors”
  • Demonstrate your ability to apply clinical judgment to DRG coding in your interview responses
    — “Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding”
  • Showcase your root cause analysis skills with specific examples from past audits
    — “Provide root cause analysis on errors”
  • Emphasize your strong communication skills and ability to work independently
    — “Excellent oral/presentation and written communication skills Ability to work independently as needed”
  • Demonstrate your ability to learn new systems quickly and meet tight deadlines
    — “Strong technical knowledge and ability to learn new systems quickly Must be able to work under deadlines”
Pace · Fast PacedCollaboration · HighAutonomy · MediumDecision Impact · Team

Derived from job-description analysis by Serendipath's career intelligence engine.

What success looks like

  • accurate and consistent clinical DRG auditing
  • process improvements
  • effective communication with peers and management
Typical background
Registered Nurse license5+ years experience in clinical validation audits

Skills & requirements

Required

Clinical Validation AuditsDRG AuditsAuditing SkillsClinical JudgmentRoot Cause AnalysisCommunication SkillsOrganizational SkillsAbility To Work Independently And In A TeamAbility To Work Under Deadlines

Preferred

MentoringProcess Improvement

Stack & domain

AuditingMonitoringDRG AuditsClinical Validation AuditsRoot Cause AnalysisCommunicationTechnical KnowledgeProblem ResolutionTeamworkIndependenceAccuracyComputer SkillsInterpersonal SkillsLeadershipDecision MakingOral/presentation SkillsWritten CommunicationOrganizational SkillsAttention To DetailFlexibilityAdaptabilityIndependent Decision-makingSelf-motivationHealthcareClinical ValidationDRG Coding

About the role

Original posting from EXL

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 $85,000 to $110,000 

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

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 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.

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.

Source: EXL careers

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