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Quality Analyst – Clinical Validation Auditor (CVA), Healthcare

$60,100 to $98,700 year

LOCATION

Anywhere

JOB TYPE

Full Time

LICENSE

RN

WORK ARRANGEMENT

Remote

Preferred Specialties:

DRG, Nurse Auditor

Posted :

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Job Description

  • 22380

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

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
  • 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

Qualifications

  • 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.

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About EXL Health

EXL Health, the healthcare analytics and digital operations business of ExlService Holdings, Inc., provides data-driven care management, payment integrity, and population health solutions to healthcare payers, pharmacy benefit managers, and provider organizations.

Headquarters: New York, New York · Founded 1999 · Approximately 65,000 employees

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