Quality Analyst – Clinical Validation Audit

EXL

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

Posted 10/5/2026full-timeRemote • United StatesMid-LevelSenior💰 $85,000 - $100,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive knowledge in DRG auditing, clinical criteria documentation, and coding validation, with a strong ability to mentor and communicate effectively. Proficient in using DRG encoder tools and industry-specific software to enhance audit accuracy and performance.

Highest-signal resume keywords

Registered NurseDRG AuditingCCS CertificationClinical Criteria DocumentationDRG Encoder Tools

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

DRG AuditingClinical Criteria DocumentationRoot Cause AnalysisAudit Trend IdentificationCoding ValidationExcel ProficiencyWord ProficiencyOneNote ProficiencyAttention to DetailTime Management

Soft Skills

MentoringProblem-SolvingWritten CommunicationVerbal CommunicationTeamwork

Tools & Technologies

Solventum/3MTruBridgeWebstratEXL Proprietary Tools

Certifications & Qualifications

CCSRHIARHIT

Industry Keywords

DRG CodingAcute Care NursingComplianceInformation SecurityRegulatory Policies

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 and ensure audits are appropriately marked for findings or no findings
Mentor Clinical DRG auditors
Use clinical and industry knowledge to identify audit trends and referrals for DRG coding review
Provide root cause analysis on errors
Use 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
Follow company Compliance, Information Security, and Regulatory policies, procedures, and programs

Requirements

What you’ll need

Registered Nurse, Associate's or Bachelor's degree
5+ years of acute care nursing experience
Prior clinical or coding validation audit experience preferred
Prior DRG retrospective overpayment identification auditing experience preferred
Prior readmission (PPR) auditing experience preferred
CCS, RHIA, or RHIT coding credentials preferred
Superior auditing and monitoring skills
Ability to mentor
Extensive knowledge and understanding of clinical criteria documentation requirements used to substantiate code assignments
Experience with DRG encoder tools (Solventum/3M, TruBridge, Webstrat)
Ability to work independently in a remote environment during EXL core business hours
Excellent time management and work prioritization skills
Problem-solving ability
Excellent written and verbal communication skills
Strong analytical skills and attention to detail
Proficiency in Excel, Word, and OneNote with general computer literacy
Passion for DRG auditing and teamwork, excellence, and collaboration

Benefits

Comp & perks

Up to 10% annual travel for team meetings and limited client onsite engagements
Exciting, fast paced, and innovative work environment
Opportunity to work closely with highly experienced, world class Healthcare consultants
Opportunities to learn many aspects of clients' businesses
Mentoring program with guidance/coaching from senior-level professionals
Opportunities for personal and professional growth
Further growth and development opportunities within EXL Health and beyond