DRG Quality Analyst IV – Healthcare

EXL

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

Posted 10/23/2026full-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. Possesses excellent mentoring abilities and communication skills to enhance team performance and ensure adherence to regulatory standards.

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 CodingRoot Cause AnalysisProcess ImprovementRegulatory ComplianceInformation Security

Soft Skills

MentoringCommunication SkillsOrganizational SkillsProblem-SolvingInterpersonal Skills

Tools & Technologies

Personal Computer Skills

Certifications & Qualifications

CICCCSCPCRHITRHIA

Industry Keywords

Clinical AuditingInpatient CodingHuman PhysiologyAccuracyFlexibility

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 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 company Compliance, Information Security, and Regulatory policies, procedures, and programs

Requirements

What you’ll need

Bachelor's Degree
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
Must be able to work under deadlines and utilize independent decision-making skills in a wide variety of situations
Requires a high degree of accuracy in varied responsibilities
Personal computer skills required
Must be self-motivated to complete work in a timely manner to meet deadlines
Strong interpersonal skills required

Benefits

Comp & perks

Benefits information provided at https://www.exlservice.com/us-careers-and-benefits
Remote office / work-from-home opportunity