DRG Quality Analyst IV – Healthcare

EXL

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

Posted 9/18/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $110,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical validation audits, ensuring accuracy in DRG coding while mentoring auditors and recommending process improvements. Possesses strong decision-making, communication, and organizational skills to effectively manage audits and compliance with regulatory standards.

Highest-signal resume keywords

Clinical Validation AuditsActive Coding CertificationAuditing and Monitoring SkillsMedical Terminology KnowledgeRoot Cause Analysis

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

DRG CodingClinical AuditingRoot Cause AnalysisMedical TerminologyHuman Physiology

Soft Skills

MentoringDecision-MakingCommunication SkillsOrganizational SkillsInterpersonal Skills

Tools & Technologies

Personal Computer Skills

Certifications & Qualifications

CICCCSCPCRHITRHIA

Industry Keywords

ComplianceInformation SecurityRegulatory PoliciesQuality ImprovementPerformance Monitoring

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
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 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
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 and meet deadlines
Strong interpersonal skills required
A brief coding/auditing assessment may be included as part of the interview process

Benefits

Comp & perks

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