Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding
Review the accuracy and consistency of clinical DRG auditing auditors
Mentor Clinical DRG auditors
Identify audit trends and referrals for DRG coding review using clinical knowledge
Provide root cause analysis on errors
Utilize industry and EXL proprietary tools in the DRG assignment process
Document audit findings and rationales in professional communications
Recommend process changes to improve quality and performance
Benefits
Innovative and fast-paced work environment with entrepreneurial professionals
Opportunities for personal and professional growth through learning various business aspects
Mentoring program pairing junior employees with senior-level advisors
Unique experiences that foster growth and development within the company and beyond
Full Job Description
Job Description
This is a remote office opportunity. The CVA Quality Analyst oversees work performed by the Clinical auditors to ensure that EXL's standard of accuracy is met. The analyst undertakes a quality review of random and targeted clinical audits. The analyst applies expert clinical knowledge in the quality auditing of inpatient medical records to confirm the appropriate validation of the provider's billed DRG code.
Salary Range: $85k - $100k
Location: 100% Remote (U.S.-based)
Up to 10% annual travel (for team meetings and limited client onsite engagements.)
A brief coding/auditing assessment may be included as part of the interview process.
Responsibilities
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
Utilize extensive clinical and industry knowledge to identify audit trends and identify referrals for DRG coding review
Provide root cause analysis on errors
Utilize industry and EXL proprietary tools in the DRG assignment process
Write professional communications documenting audit findings and supporting rationales.
Recommend process changes to improve quality and performance
Communicate with peers and management
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
Qualifications
Registered Nurse, Associate's or Bachelor's degree
5+ years of acute care nursing experience with preference given to candidates with prior clinical or coding validation audit experience.
Prefer candidate with prior DRG retrospective overpayment identification auditing experience.
Prefer candidate with prior readmission (PPR) auditing experience.
Preference given to candidates with CCS, RHIA, or RHIT coding credentials.
Knowledge and Skills:
Superior auditing and monitoring skills
Ability to mentor
Extensive knowledge and understanding of clinical criteria documentation requirements used to successfully substantiate code assignments.
Experience with DRG encoder tools (Solventum/3M, TruBridge, Webstrat).
Works independently in a remote environment and delivers exceptional results during EXL core business hours.
Possesses excellent time management and work prioritization skills.
Takes ownership of problem solving.
Demonstrates excellent written and verbal communication skills, strong analytical skills, and attention to detail.
Proficient in Excel, Word, and OneNote with general computer literacy.
Passionate about DRG Auditing with a desire to work in an environment thriving on teamwork, excellence, collaboration
What we offer:
EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants
You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills-key aspects for personal and professional growth
We provide guidance/coaching to every employee through our mentoring program wherein every junior-level employee is assigned a senior-level professional as an advisor
The sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond
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.
About EXL Service
EXL Service is a leading operations management and analytics company that helps businesses enhance growth and profitability. The company provides services in areas such as finance and accounting, customer service, and healthcare. EXL Service was founded in 1999 and is headquartered in New York, New York.
