DRG Quality Analyst IV – Healthcare

EXL

. Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding .

Posted 11/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $110,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical validation audits with a strong focus on DRG coding accuracy and compliance. Capable of mentoring auditors while providing root cause analysis and recommending process improvements to enhance quality and performance.

Highest-signal resume keywords

Clinical Validation AuditsActive Coding CertificationAuditing And Monitoring SkillsMedical Terminology KnowledgeDecision-Making Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

DRG Coding AccuracyRoot Cause AnalysisProcess ImprovementClinical JudgmentAttention To Detail

Soft Skills

Mentoring SkillsCommunication SkillsOrganizational SkillsInterpersonal SkillsAdaptability

Tools & Technologies

Personal Computer Skills

Certifications & Qualifications

CICCCSCPCRHITRHIA

Industry Keywords

ComplianceInformation SecurityRegulatory PoliciesMedical TerminologyHuman Physiology

About the role

Key responsibilities & impact

Apply clinical judgment for DRG audits to ensure accuracy of inpatient DRG coding
Review the accuracy and consistency of clinical DRG auditors’ work and 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 in accordance with company Compliance, Information Security and Regulatory policies, procedures and programs

Requirements

What you’ll need

Minimum 5 years of experience working with clinical validation audits
Active Coding Certification: CIC, CCS, CPC, RHIT, or RHIA
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
Ability to work under deadlines and utilize independent decision-making skills
High degree of accuracy in varied responsibilities
Personal computer skills
Self-motivation to complete work timely and meet deadlines
Strong interpersonal skills

Benefits

Comp & perks

Work from home / remote work opportunity
Benefits information provided via EXL’s US Careers and Benefits page